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ECM software encourages interoperability, addresses meaningful use

By adding structure to data in EHR and PACS silos, enterprise content management software can help health care providers achieve the interoperability that meaningful use requires.

Enterprise content management (ECM) software emerged roughly two decades ago, but, like much information technology, it has been slow to catch on in the health care industry. This article is the first in a four-part series that explains the benefits of ECM software, including improved interoperability and medical record storage, and provides tips to health care providers shopping for an ECM system.

Health care CIOs don't know it, said health IT consultant Deborah Kohn, but problems of interoperability between data silos such as physician electronic health records (EHR) and radiology picture archiving and communications systems (PACS) can mostly be boiled down to adding structure to unstructured data, or "content" in IT parlance. This involves taking all the audio, video, images, electronic forms, email, paper scans, faxes, and other documents germane to patient care that currently float around on the network -- presently incompatible with an EHR system -- and making them compatible by adding structure.

In fact, it could be argued that meaningful use simply makes it mandatory to give structure and organization to all this unstructured content and bring it together in the EHR with already-structured content. 

Enter ECM software. It might be new to health care, but it isn't a new idea at all.

In the early 1990s, ECM software evolved from enterprise document management systems, as large businesses struggled to migrate from paper to digital workflows and integrate the content with Microsoft Office files, emails and faxes. These applications added structure to what essentially was a giant stew of unstructured data -- including documents originating on-screen as well as scanned paper documents.

The big meaningful use problem ECM software can help solve is integrating disparate information systems.


Sound familiar? Thanks to meaningful use mandates, a similar migration from paper patient files to EHR systems is taking place today. As a result, health care ECM software has new relevance, at least for facilities that still have parts of their workflow stuck in paper -- or need to pull documents into their EHR systems from practitioners who do not qualify for the EHR Incentive Programs and, therefore, are in no hurry to convert to electronic processes.

Once providers solve the paper-to-EHR workflow problems, they quickly realize that unstructured content that starts out in digital form -- email, electronic forms, PACS images and so on -- is also part of the problem and needs to be collected into the EHR system. This is necessary not only to give physicians a more complete patient profile during the course of care, but also for records management and regulatory retention compliance, and sometimes for e-discovery in legal proceedings.

How ECM software helps enable interoperability

Traditional large ECM vendors such as OpenText Corp. typically are not used in health care facilities, said Kohn, principal of Dak Systems in San Mateo, Calif. Two exceptions are EMC Corp. and IBM, the latter of which claims more than 650 hospitals among its customers. Both compete with a slew of smaller vendors, including Hyland Software Inc., CGI Group Inc. and Perceptive Software LLC. The aim of all is to gather content from disparate sources and automate their organization.

The larger the vendor, the more sophisticated the structure they can add to data -- such as dealing with pixel data in bitmap images, Kohn said. They all can handle optical character recognition (OCR) of scanned paper documents, making them searchable. ECM software assigns metadata to documents along the "classifying expressway," as CGI's website calls it.

The big meaningful use problem ECM software can help solve -- and the reason it's attractive to hospitals and provider networks right now, as they roll out EHR systems -- is integrating disparate information systems. And, when one considers paper itself is an "information system," perhaps the most common use of ECM software is porting the elements of a health care provider's clinical workflow still mired in paper to an EHR system. However, one shouldn't confuse "ECM" with basic applications that digitize and run OCR on paper documents.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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