Healthcare has evolved in a way that allows providers to collect an unprecedented amount of data quickly. These data goes beyond patient care records used by physicians to include information collected and used by ancillary departments across a practice or hospital, such as billing and payroll. But if this vast data are not collected, managed, and made accessible in a way that meets the needs of physicians, administrators, and patients, then what good are they?
This blog will examine the shift from paper-based record-keeping to electronic health records (EHRs), and ultimately to harnessing data through enterprise content management (ECM).
As recently as 10 years ago, hospitals and physicians were using primarily paper-based systems. However, as the Internet, computers, and other record-keeping technologies became less expensive and widely available, hospitals began to utilize computerized order entry systems (CPOE). CPOE, sometimes referred to as computerized provider order management (CPOM), is a process of electronic entry of medical instructions by the physician for the treatment of patients (particularly hospitalized patients) under his or her care.
When first introduced, CPOE helped hospitals reduce delays in order distribution, resource allocation, and order completion, while reducing errors related to bad handwriting. These systems also allowed physicians to order services at the point of care, reduce duplicate tests and incorrect doses, and simplify posting of service charges for the patient.
The center of this records system was Document Management and Imaging (DMI). Beginning in the 1980s, a number of vendors began to develop software systems to manage paper-based documents. These systems dealt with paper documents, which included not only printed and published documents, but also photographs and prints, such as from imaging tests. DMI enabled a hospital to capture faxes and forms, save copies of the documents as image files, and to store those image files in a repository with secure, fast retrieval.
The shift to enterprise content management
In March 2010, President Obama signed the Affordable Care Act (ACA) into law. One provision of the ACA is the implementation of EHRs. EHRs allow healthcare providers to record patient information electronically instead of using paper records.
As most of you know, the Medicare and Medicaid EHR Incentive Program provided incentive payments to eligible healthcare professionals, hospitals, and critical access hospitals as they adopted, implemented, upgraded, or demonstrated meaningful use of certified EHR technology.
To meet these requirements, hospitals and physicians evaluated vendor platforms, allocated time for managing internal staff training for documentation to attest to providing patient care. Software vendors focused on meaningful use as the dominant aspect of their product roadmaps. For the CIO and the CFO of hospitals and physician organizations, all eyes were on reimbursement for attestation and efforts to install and use software for much more than just order entry.
With the change, the document management solution still remained a required element of a complete legally viable and reproducible medical record; but the end-user focus shifted to the EHR. And so DMI vendors addressed the need to more fully automate the collection and use of data in conjunction with the EHR. This initial move to ECM had significant impact on the number of former DMI vendors that chose to remain in this space, winnowing away at those providing these services. A similar impact occurred to the number of EHR vendors.
The focus had shifted to what has come to be known as interoperability and business process automation to enable data and document sharing well beyond an end user’s ease of use accessing multiple systems with a single sign-on password. ECM software and service providers began to be tracked and evaluated by companies such as Gartner, Forrester, and KLAS.
ECM product vendors began to incorporate new technologies and methodologies. Simple workflow routines gave way to using technology for more complex and multi-step front-to-end process automation. The use of optical character recognition was also included to simplify the manual work associated with scanning and indexing documents. Hospitals and physician offices had so much more data and documentation to collect and manage, and that included electronic referrals, electronic EOB files for claims reconciliation, and their own online purchase order or staff recruitment resumes.
Taking it to the next level
Today, as technology continues to advance with everyone using smart phones, healthcare is more democratized and there is a need to move from document and content management to enterprise content solutions (ECS). ECS encompass all the solutions afforded by its predecessor technologies, including DMI and ECM, with a focus on meeting expectations relative to speed to market and data availability.
The evolution to ECS was born out of the realization that a centralized platform often requires complex integration to deliver information for sharing and that even the most sophisticated technology companies cannot meet the personalized demands for innovation.
Today’s reality is that healthcare provider organizations are living in a multi-repository world and their end users and stakeholders – patients, management, payers and auditors — demand specific solutions to their unique business problems. They need these solutions now, as opposed to waiting for a general solution to be installed in a 12- to 14-month time frame.
ECS and modern software development methodologies to deliver content applications are designed to provide configured solutions quickly.
Quanum Enterprise Content Solutions (formerly known as ChartMaxx) integrates all clinical and business content for healthcare organizations and includes an enterprise search tool to enable insight discovery and to bring value back to content.
Understanding and adopting an ECS approach will help health systems enable content solutions to be delivered quickly and cost effectively, and meet emerging business innovations, while still maintaining the fundamentals of an appropriate level of information governance, security, and risk management. Imagine being able to order data with as much ease as you can now reserve a table or buy a product online. That’s the direction to which ECS is moving, with on-demand, keyword-searchable capabilities providing convenience, ease of use, and seamless integration into a health system’s workflow. That is the future of content management solutions.