Solutions

The Path to Paperless in Healthcare

One of the greatest challenges to a fully digital healthcare system is transitioning the paper intensive documentation process. There are many hurdles to overcome: low operating margins and high cost of goods and services, training in a staffing environment of high turnover and potentially lower education levels, strong resistance to change and lack of system and process consistency across the healthcare continuum. Trying to tackle all of these barriers in one fell swoop often proves too much for providers and their discouragement leads to inaction and continuation of an inefficient paper process.

Healthcare software companies have made great strides in providing digital means by which a provider can view patient information, both individually and collectively. These systems help maximize the effectiveness of patient care as well as monitor the operational health of the providing agency or facility.
 
But how does the data from the documentation collected by healthcare staff find its way into an EMR or analytics engine? According to a CBS Market Watch report, an estimated 90% of all patient information remains on paper (Healthcare Document Imaging Trend Report – Fujitsu). Making a leap from paper to digital entry of patient data overnight is virtually, if not totally impossible for any provider. A transition process is the only feasible answer to successful transition.
 
Imagetek’s Automate. Integrate. Accelerate. (AIA) methodology was built on the premise that a paper-to-digital transition is an evolutionary process, a Path To Paperless. Rather than imposing instant and sudden change, AIA takes a more logical and evolutionary approach helping an organization realize immediate and tangible benefits in overall cost and workflow.
 
Step 1: Automate
Replaces the act of filing paper, creating a transparent repository for easy retrieval.
 
Step 2: Integrate
Capture is advanced to the point of receipt, facilitating electronic processing of transactions.
 
Step 3: Accelerate
Maximizes digital transactions for all stakeholders while educating the customer to achieve the highest level of autonomy.
 
This paper will demonstrate how each step of AIA is applied to the transition of healthcare documentation from a paper world to an electronic one, and how implementing this process in conjunction with a fully functional EMR and/or analytics engine is the most efficient and realistic way to get on the Path To Paperless with healthcare documentation.
 
 
Automate.
 
The first step is to automate, standardize and centralize the paper, digital, structured and unstructured content. By capturing, identifying and storing documents and data, instantaneous and tangible benefits are realized without major disruption to vital resources; the information and people.
  • Minimal system entry cost
  • Identification and standardization of the various types of business content and the originating file format
  • Centralization, online and simultaneous access to all the content surrounding a patient or business transaction
  • Enables compliancy and security with federal and state mandates and internal policies and procedures
  • Gradual transition of employees from a manual to a digital environment
As illustrated in the statistic provided previously, the vast majority of healthcare documentation continues to be initiated on paper. With the continued progression toward adopting electronic systems to manage patient data, providers are challenged to find an efficient and cost-effective way to retain that original documentation and associate it with the electronic data for that patient. Although EMRs are growing in popularity, if paper is used to capture the information, that document must still be retained in some form as the original documentation for a specific patient interaction.
 
In the Automate phase, very little changes in the day-to-day process for healthcare staff performing documentation. Patient information is still collected on the same paper forms they are used to, eliminating the need for extensive training or the purchase of additional hardware for digital collection.
 
So what changes? Instead of retaining the paper in a physical chart that is separated across mediums from the EMR data, the paper documentation is scanned via IP connected scanner directly into the EMR as an imaged document that can be indexed to reside in association with the appropriate patient data. This step allows the healthcare provider to have access to living data as well as transparent and efficient retrieval of the original documentation captured in time.
 
Although this step is far from being paperless, the retention of a digital image of the paper documentation gets a provider on the Path To Paperless without major disruption to processes and financial resources. Making the original paper documentation available in digital form that can be linked to patient data in a provider’s EMR allows for more efficient retrieval processes by all levels of healthcare staff. The direct scanning process also minimizes human error by eliminating the possibility of misfiled or misplaced forms and unauthorized access in violation of HIPAA laws.
 
In addition, retaining a scanned image of the original paper documentation now ensures its security in the case of a disaster, as well as enabling healthcare providers to quickly access vital patient documentation in an emergency.
 
 
Integrate.
 
After the automation stage has progressed and shown success within an organization or department, the move to the integration stage becomes a logical and easy next step. The integration stage includes not only integration of documents and data into your information systems but also into your existing business processes and people.
  • Processes are more efficient in their delivery and timing
  • Functions can be performed simultaneously
  • Empower good decision making through the immediate access and delivery of relevant documents and data
  • Link disparate software and functions through common data or documents
  • No expense or risk of processing paper files
  • Identifies weak or redundant activities within existing processes
Greater value can now be gained from the original documentation by directly integrating the data captured on paper into an EMR or analytics engine. Now, in addition to simply capturing an image of the paper document, information can be identified and extracted to further integrate the document with the information residing on a patient in an EMR.
 
For analytics purposes, specific data that one or several forms collect that have clinical or business significance can be extracted and inserted into an existing analytics engine directly from the application specific scanner interface.
 
With the ability to identify specific form sets via barcoding and implementing zonal OCR to recognize, extract and associate appropriate data on the backside of an existing system, less time is spent keying information from paper documentation.
 
To further the integration of paper documentation into an EMR or analytics engine, existing forms may be re-designed in totality to completely digitize all of the information captured in the field by healthcare staff. Additional time and effort will be required for this step however, it continues to eliminate the need to invest in additional hardware and extensive training for healthcare staff.
 
 
Accelerate.
 
Within the acceleration phase, an organization is no longer handicapped by ineffective information and process management. With information, people and business processes effectively and efficiently aligned, an organization is empowered to accelerate the pursuit of their strategic initiatives and growth plans.
  • Realized ROI through effective and efficient processes
  • Competitive and strategic positioning that allows growth and change as necessary
  • Information and processes are enablers, not disablers, to growth and effectiveness
  • Elegant, defined and flexible processes
  • Proactive patient care and business management
Now that information is readily available in digital form internally, the vision for Acceleration moves externally, to information sharing across the healthcare continuum. Being able to take information, in whatever form it is provided, and incorporate it into internal systems.
 
Part of that vision is the development of strategic methods and structure surrounding how healthcare providers capture, develop and share patient information. The continued growth of the Clinical Document Architecture (CDA) initiative is an example of this.
 
The continued advancement of CDA provides for an exchange model addressing clinical documents (such as discharge summaries and progress notes) - and brings the healthcare industry closer to the realization of an electronic medical record. By leveraging the use of XML, the HL7 Reference Information Model (RIM) and coded vocabularies, the CDA makes documents both machine-readable - ;so they are easily parsed and processed electronically - and human-readable - so they can be easily retrieved and used by the people who need them. CDA documents can be displayed using XML-aware Web browsers or wireless applications such as cell phones (Health Level Seven, Inc.).
 
In Accelerate, healthcare providers are no longer isolated in their efforts to learn more about their patients in order to deliver the highest levels of care. The operational viability of an agency or facility is no longer in jeopardy due to lack of easily accessible demographic and regional information exchange. Patients are no longer responsible for tracking down and acquiring health information that they do not understand.
 
As our healthcare system evolves, the AIA methodology allows providers to walk alongside, not trail behind. It is unrealistic to expect that all elements of our healthcare continuum will adopt electronic means of documentation at the same rate and arrive at a paperless state at the same moment. Allowing for the automation and integration of paper into the electronic healthcare world moves us farther along the Path to Paperless toward an accelerated delivery of care.

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