Health care organizations in the market for enterprise content management (ECM) software have a couple options. One is to purchase a standalone ECM system. The other is to turn to their electronic health record software vendor, which might offer its own ECM software application or module along with its EHR system.
Buying into that isn't necessarily a good idea, said Cathy Fuhrman, manager of information systems at San Diego-based Sharp Healthcare. In her mind, for ECM software to be effective across a health care facility, it should be able to port unstructured content into more than just the EHR system.
"[They're] usually eight times the cost of a normal ECM system, and they only work with their [electronic medical record]," Fuhrman said. The four-hospital organization uses a Cerner Corp. EHR system connected to a standalone Hyland Software Inc. OnBase ECM software, which can be accessed within the EHR when a physician or staff needs to add a document. (OnBase also integrates with EHR software from Allscripts Healthcare Solutions Inc. and Epic Systems Inc., Fuhrman noted. A Hyland spokeswoman said the company plans to get OnBase meaningful use certified.)
For ECM software to be effective across a health care facility, it should be able to port unstructured content into more than just the EHR system.
While Sharp's various hospitals and physician groups boast a 95% use rate for computerized physician order entry (CPOE) systems, they still use paper charts. The ECM system helps collect and organize paper records from many different installations, including non-Cerner systems used in Sharp's pathology and radiology departments.
The ECM software can route documents to all of those departments. It also manages document flow to a new patient portal -- which Sharp currently is getting certified for meaningful use -- where patients can view records and billing information and schedule appointments. (Officials have said that IT systems developed in house will have to be certified.)
Outside the clinical workflow, Sharp uses its ECM system to organize supporting documentation for back office processes such as claims processing, enrollment/eligibility and utilization management.
Fuhrman sees ECM software as a permanent interoperability link between the various information systems and paper. "I don't think you'll ever get rid of all the paper," she said. For example, when an unaffiliated physician -- typically using a different brand of EHR -- needs to pass patient data to Sharp before scheduling a surgery, he typically faxes in charts from his EHR system. That information needs to be ingested into Sharp's EHR via the ECM software.
Points to ponder when evaluating ECM software
Along with their usual evaluation criteria, Kohn advised IT leaders at facilities considering ECM software use total cost of ownership comparisons to help narrow the choice of ECM vendor. In some facilities, going with an EHR vendor's ECM software might be cost-effective -- even if it does, in fact, cost eight times as much. If, for example, it requires a much smaller investment in employee training, integration and IT support, then the EHR vendor option could end up costing less in the long run.
Deborah Kohn, principal of Dak Systems, a health IT consultancy based in San Mateo, Calif., gave the technical edge to standalone ECM software over modules that an EHR vendor might publish or license from another software company. However, while standalone ECM software may be less expensive and more robust, it leaves providers with "the whole interface and interoperability issue…to deal with, and that's never pleasant."
Health care providers leaning toward ECM modules from their EHR vendors also need to closely examine integration, Kohn added. It might seem simple in theory, but there could be instances in which the EHR vendor publishes or licenses the ECM module without doing much to integrate it with its own systems.
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