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Using ECM systems to manage unstructured patient data

many providers' best efforts, much patient data remains on paper, CDs or other unstructured formats. Enterprise content management can help, but it's a hard sell to CEOs

As noted in the previous installment of our series on enterprise content management systems in health care, ECM systems can reduce the medical storage footprint. It has done that and more for Baptist Health South Florida, which has also incorporated electronic forms from its ECM software into business and clinical processes.

That said, there's still a lot of paper in Baptist's clinical workflow, according to Lisa Morris, corporate director of clinical business systems and revenue cycle. The paper comes from processes such as patient consent forms -- Baptist has not yet enabled electronic signatures -- and from more than half of the 3,000 physicians affiliated with Baptist, since they do not yet use electronic health record (EHR) systems.

Because of this mishmash of content, one of the most important jobs the ECM software does -- which the electronic health record (EHR) system cannot do -- is maintain the legal repository for a patient's care. This involves tracking all documents, not all of which can be integrated into the EHR system.

"We have a lot of retired folks coming here, traveling for the winter and being up north in the summer months," Morris said. "We do have a lot of records that are flowing on paper back and forth -- or at the very least on CD -- where we are importing that information."

Baptist is seeing more transfer of electronic medical records over the Internet via File Transfer Protocol (FTP), too. Fortunately, Morris said, the facility's ECM software -- Sovera, from CGI Group Inc. -- supports multiple means of including data in legal records.

Because of the variety of formats in which Baptist receives documents, Morris doesn't see an EHR system ever being able to support a full legal record, to see a patient's full story, any time soon. Even when every physician gets on an EHR system, she added, "There will be various specialties throughout the organization where the EHR just doesn't fit."

ECM systems aren’t an obvious choice for health care CIOs

While ECM systems can resolve many interoperability problems among health IT data silos and also bring paper into the digital workflow, Deborah Kohn, principal of Dak Systems in San Mateo, Calif., said they are not an obvious choice for many hospitals.

"When [providers] start getting deluged with unstructured data…then they'll start realizing they need to interoperate and they realize they need something to manage all [of it]."

Deborah Kohn, principal, Dak Systems

CEOs see the need for EHR systems, transcription services and picture archiving and communications system (PACS) implementations, but when it comes to ECM systems, she said, “I just don't think anybody gets that.”

Even when it occurs to providers that ECM systems might be a good fit, they often go a different direction, Kohn continued, opting instead for a patchwork of paper-scanning utilities or transcription software to port unstructured content to an EHR.

That's because CIOs are too caught up with federal mandates -- specific meaningful use criteria such as implementing certified EHR software and getting patient data reporting systems on line, managing the transition to International Standard of Classification and Diseases, Tenth Edition (ICD-10) codes and preparing to support the accountable care organization (ACO) requirements laid out in a recent proposed rule.

Kohn thinks the trend of eschewing full-blown ECM systems will continue for the foreseeable future, even if it might be the better path of action.

"I just talked to a potential customer…going from paper to their very first EHR. They have a very big job to do just to get that online,” Kohn said. “Somewhere along the line, they will realize that an EHR is not just structured data. When they start getting deluged with unstructured data -- and there's tons of it that clinicians use every day -- then they'll start realizing they need to interoperate and they realize they need something to manage all [of it]."

It may take years for it to dawn on hospitals that they need an ECM strategy, Kohn said. If the fact that a hospital is hemorrhaging patient data in email doesn't spur an ECM implementation, social media could eventually tip the scales. Thatwill be the next wave of unstructured content that health care IT leaders will have to integrate into EHR systems.

"Health care still isn't dealing with email," Kohn said. "I preach [to clients] all the time that email's a key area they have to get their hands around, but very few are listening."

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


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