Implementing Document Management Solutions

Dan Waltz, VP and CIO, MidMichigan Health
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With all the work being completed for data analytics, one may ask why do health care systems need a document management system. From a pure analytics standpoint, it would be best to have discrete data in the database and warehouses for reporting and business intelligence purposes. Not all data is able to be entered discretely into even the best electronic medical record, patient access and revenue cycle systems. Patients provide paper documents, consent forms, legal forms, revenue cycle correspondence which all need to be retained and easily accessible.

Hosted Solution to Integrate EMR

When considering cloud-based solutions versus a hosted solution a total cost of ownership should be projected for 5-7 years. Volume considerations for performance must also be reviewed. There must be a positive ROI before selecting a cloud-based solution. MidMichigan Health is implementing a hosted stand-alone vendor that integrates tightly to the EMR vendor mostly through APIs.  which from the customer’s do not even realize when they exit and enter the software to scan and retrieve documents. For bulk scanning, workflows should be evaluated on efficiency and number of steps to attach the document to the actual patient chart. Too many steps will result in unexpected FTE growth.

  Keeping the software on the latest versions can avoid expensive upgrades and potential replacements when the technology outpaces the environment 

Understanding and reviewing a vendor’s workflow integration while considering a new system is advisable to derive the desired outcome. There are many good vendors in the market and some of them integrate tightly into the EMR system. Other EMR vendors have self-contained solutions which are great.  Analysis needs to be complete prior to purchase as to whether standards are used so that documents may be converted and the cost of the vendor conversions upon terminations of the contract should be considered. Data conversion for new projects usually takes months to move the images. There also must be a hardware build out for the conversion process. Most vendors are solid in estimating the resources, cost and time to complete. The vendors can provide the service in most cases and are flexible allowing health systems to complete the processes themselves if they have qualified staff and time to complete.

Health system strategy must be considered when selecting a vendor. MidMichigan Health is striving to obtain the highest EMR Adoption Model score of 7 on the adoption model and currently is at stage 6 for both acute and ambulatory services. Stage 7 requires scans to be completed within 24 hours of presentation and ideally at the point of service. It is important to review the vendor’s individual offerings so that the organization understands what is being purchased. Vendors typically try to sell the entire suite. Looking beyond the immediate needs and at the long term strategy helps to understand how this solution may advance the strategy. Organizations should plan to complete a master contract at least three months prior to starting work. Three vendors should be selected in the RFP (Request for Proposal) process. Id is advisable to  use a detailed RFP that includes your terms and conditions. The suppliers must sign off to key master agreement terms before they will be scheduled for a demo.

Physicians have some of the most unique and challenging jobs in the world. It is not unusual for physician to be at their children’s after hour activities completing charts and preparing themselves for their next day’s appointments. They access the patient’s record including all images and documents. This is also a good physician recruitment tool because it allows maximum flexibility in the growing complexity of managing patient care. IT departments must elevate the position of the security officer to constantly monitor and improve security around these solutions.

Keeping the software on the latest versions can avoid expensive upgrades and potential replacements when the technology outpaces the environment. MidMichigan Health has an unwritten rule to stay within two versions of the current software and usually begin upgrades around six months after the general release. We don’t have the staffing to be on the bleeding edge.

With a successful implementation and full functioning document management system can improve patient care and contribute to improved business intelligence information and physician satisfaction.

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