Thursday, March 29, 2012

Document Management and EMR

Paper will be with us for a while...
After a visit to a tradeshow such as HIMSS, it is always hard to get back to the real world where, instead of everything being available electronically, there are still a lot of faxes, paper EKG’s, consent forms, patient questionnaires, and old paper charts and loads and loads of other paper documents to deal with. Managing these documents in an electronic system such as an EMR is not a trivial matter. It requires a lot of work to scan them in and properly identify and index them. Traditional document management systems have been around for quite a while. I looked at some of the text books on this subject and some of them date back from the early 90’s when we were just beginning to think about EMR’s. At that time, an electronic patient record involved scanning every piece of paper into a document management system, which obviously was time consuming and does not provide any of the advantages that electronic information provides such as coding, decision support and the many other benefits of an EMR.
So, how do we deal with all these paper documents? As a matter of fact, scanners have become rather sophisticated. There are high volume production scanners on the market that can take in a stack of hundreds of documents and scan them at high speed, often scanning both sides, along with software that can automatically index the documents and recognize the patient record and type of document. The initial somewhat crude optical character recognition (OCR) has now advanced to what is called “zonal OCR” where one can instruct the software to look at a certain region, and can even be extended to ICR, which can also include handwriting. Most of this technology was not developed uniquely for medical applications. I am sure many of you are familiar with the recognition of handwriting that is widely being used to scan in checks at an ATM. Documents can be scanned directly into a database or management system such as Sharepoint, which can easily be interfaced with a EMR.
One of the challenges from an operational perspective is who is going to scan all of these documents in and make sure that they are properly indexed? There is an analogy with the transition from film to electronic imaging. In that case, the file room clerks were typically trained to scan films into the PACS system and ensure that they did end up in the right patient record. The same will have to be done with paper records, in this case, the front office or dedicated clerks will take care of this. As a matter of fact, one of the VA hospitals I visited had a whole department whose sole job is to scan all of the paper records and forms. They were one of the early hospitals to claim to be totally paperless. There is a challenge with training and educating these employees on the scanning technology and the basics of electronic records. To help improve quality and standardize document management practices, OTech has developed a certification program for Certified Healthcare Document Management Administrators (CHDMA) and a certification exam through a grant from Eastman Kodak Company. Document management will still be important as there will be paper around for the foreseeable future. It is important to have qualified, and if possible, certified personnel managing the processing of these documents.