Let's start with a hypothetical scenario. I woke up to the sound of my car horn blaring and a woman standing over me with a golf club. My car was conveniently parked against a tree, with a plume of water shooting over my head like fireworks from a nearby fire hydrant. My chest hurt - a lot.
When I got to the hospital in the ambulance, I informed them of the pain. They told me they were going to do an EKG just to be sure everything was okay. I shared that I had just had an EKG done at the same hospital two weeks ago. They got on their fancy computer and pulled up my “electronic medical record.” Unfortunately, the nurse informed me that my EKG didn’t show up because that wasn’t ‘structured data’ that fit nicely in their EMR. The nurse said that my EKG was in a paper chart down in Medical Records – which was closed for the night. I said, “Do you know who I am?”
Okay, I’m not Tiger Woods. I never thought I’d be happy to say that – but I am!
As our country becomes increasingly focused on healthcare, whether it be the cost or quality of care, providers remained vexed by a common IT concern: Even with the significant investment in an Electronic Medical Records package, there is still paper everywhere. The reasons for that are abundant and will remain for years to come.
As the government highlights things like ‘meaningful use’ and the sharing of content between physicians, hospitals, and patients across facilities and geography, the need for a holistic Electronic Health Record regardless of the content’s origin – paper or electronic – has never been more critical. Whether the focus is on reimbursement rates, grants, federal funding, or the patient safety issues that are the genesis of those financial incentives, one record at a physician’s fingertips or lost in a critical care scenario may be the difference between life and death; for the patient and for the hospital.
So, next time you're a patient at a hospital, here are eight reasons why you’ll feel safer if that hospital has ECM for their electronic medical records:
Access to external documents
It’s 3 a.m., and you’re in the emergency room. But you can’t talk. Remember all of those records you brought with you last time you were at the hospital for outpatient surgery? Lab work, radiology report, physician notes…all on paper. Where did those records go? With an ECM integrated with the hospital’s Electronic Medical Record, your physician doesn’t just have the hospital’s notes from your previous visit, but all of that external documentation was scanned in and is now a click away in the EMR interface where the clinician can now see a more complete history prior to providing treatment.
Access to medical records in the hospital
Unfortunately, after visiting the ER, you are admitted. Even in heavily automated hospitals, you will often find that Emergency Department charts are still kept on paper. However, that paper ED chart may not always ride with you to your room. Scanning that chart into the hospital’s ECM system linked to the EMR allows any clinician with security rights to see your chart info in the EMR to access your info. So whether you end up on a regular floor, ICU, Radiology, or Lab, you can rest in that morphine-induced happy place knowing that your caregivers can access all of your information since entering the hospital.
Always on
In today’s growing world of outpatient services, hospitals and their affiliates are often sharing chart info between facilities. The good news is that AnyTown Hospital may, in fact, be the keeper of all of your records because you go to AnyTown physicians, AnyTown Radiology, and AnyTown Orthopedics. Unfortunately, as you arrive at the ER, your paper chart info hasn’t come back from AnyTown Outpatient Surgery Center, and your file is ‘out.’ With ECM, your file never moves. No faxing. No couriers. One file – online. Available to all of AnyTown’s caregivers through their EMR interface.
Diagnostic data
While healthcare providers are adopting scanning technologies in rapid numbers, they are only scratching the surface of ECM capabilities. Upper-tier Content Management products are truly object repositories – not just electronic file cabinets for scanned paper. So content such as audio files and video files could be dictation recordings and surgery videos available through your ECM. Digital photos for things like wound care, dermatology, or burn units can all be easily imported into your ECM. Forward-thinking thought leaders are even beginning to leverage ECM as middleware. Diagnostic info, e.g., EKGs, Fetal Monitors, Holter monitors, and more, are not integrated with the EMR in most cases. Printed copies of Fetal Monitor strips are often taped to pages in a paper chart. Your history of EKG’s are printed off and kept in paper form and may not be available for reference as you enter the ER suffering from chest pain. With ECM, direct device integrations can be done to electronically receive, store, and integrate this data for instant availability directly through the EMR interface.
Patient safety
Clearly, greater availability of information at the physician’s fingertips could be the difference in critical care scenarios. Lawmakers offhandedly cite ‘medical errors’ as the premise for electronic medical records. The term though is, in most cases, a misnomer labeling physicians as having made errors. Unfortunately, their ‘error’ was, in fact, a lack of available information. While EMRs are a step in the right direction, most industry data states that at least 20% of the chart remains in paper-form today, leaving physicians and patients alike in a precarious information deficit. With ECM, that paper is scanned and available, integrated through the EMR, creating one holistic record.
Privacy
A quick read of the HIPAA regulations is not only a great cure for insomnia but magnifies the vagaries of ‘private information’ in a paper world. While great care is taken in defining rules and regulations around the securing of electronic data, one would argue that the standards as they apply to paper records are a bit more challenging to enforce. Copies, faxes, couriers, outsourced paper storage providers all present potential challenges in enforcing secure access. A well designed ECM security model ensures that only authorized users access your documents; even printing can be controlled. In addition, an audit trail logging every user who accesses any document in your chart - and even any action they perform while viewing it – provides peace of mind that your Personal Health Information is secure.
Release of Information
Whether it’s a move to a new city, a new physician, or a new health insurer, you may need your records in a portable form. While EMR’s can produce a report for you, paper charts – if immediately accessible may need to be copied, faxed from multiple locations, pulled from offsite storage, etc. Healthcare focused ECM products often contain the ability for the hospital to go through a simple ROI workflow to produce all of the scanned components of your chart along with your EMR report. In fact, some ECM/EMR integrations offer the ability to do that through the EMR as a singular process.
Scalability and Integration
A number of EMR’s offer document imaging as native functionality. However, scan and store capabilities within an EMR should not be confused with the breadth of functionality a true Enterprise Content Management system can offer. Whether it’s being tied down to strictly scanned content, or in many cases, an architecture reliant on database blobs for the storage of image objects that limit scalability and ultimately hamper performance, the functionality chasm is severe. Imagine yourself in the bed in the ER as your clinician waits for your chart’s scanned images to load for minutes in some cases. Top tier ECM products have been scaling to billions of images and terabytes of data in numerous vertical markets for decades now. So, why might a hospital buy the EMR’s document imaging functionality? Because it’s ‘integrated.’ However, whether it’s HL7, Web Services, APIs, or screen scrape technologies, peeling back the layers of an EMR’s ‘integrated scanning’ will often yield little more or even a weaker integration than many ECM’s can provide out of the box.
Soon, the landscape will be changed. I will be worried less in the ambulance about what hospital they are taking me to, but rather what is their IT infrastructure to make sure that my physician has all of my chart information available throughout my care cycle? I sure hope they have ECM for their EMR.