Driving costs out of Healthcarein the Digital Age

Cathy PaichRegional Vice PresidentXerox Healthcare Provider Solutions

Jim LeonardDirector of Healthcare Business DevelopmentGRM Document Management

Overview

Hospitals today need to efficiently process a myriad of diverse documents. 

Even with the promise of increased automation and standardization brought about by industry dynamics and compliance with government mandates – the bulk of information exchanged today would still be categorized as “unstructured” and is destined to be around for many years to come.

The industry is now moving aggressively to capture and exchange this unstructured information (with appropriate linkage to structured data) to achieve a broad range of goals, including:

• Improving and automating workflows, 

• Reducing costs, 

• Increasing compliance, and

• Improving clinical and operational collaboration

The means to achieve this is via a comprehensive enterprise content management and business process management strategy (ECM/BPM).  

This Requires a complete suite of components to integrate documents and workflows across the organization, both digital and paper, with advanced business process management tools.

What is Enterprise Content Management?Enterprise content management (ECM) and workflow tools enable hospitals to capture, manage, store, preserve and collaborate on important documents and information across the enterprise.

ECM and workflow tools seamlessly integrate existing MFD technology and existing clinical and financial applications – including Lawson, SAP, HIS and EMR platforms such as Cerner, Meditech and Epic. 

These ECM tools support a hospital’s EMR and “paper‐lite” strategies by capturing and linking unstructured data (documents, faxes, etc.) with structured data. 

Once a document is captured as an electronic image, it becomes a searchable, shareable resource that can be accessed from anywhere.  Images can also be mined for their data in order to drive business transactions and improve and automate workflow.

Key Drivers ‐ Benefits: Process quality and efficiency – increased automation – productivityImproved data qualityImproved clinical/operational collaborationReduced costs Increased compliance & security (HIPAA, Meaningful Use, etc.)

ECM – The Opportunity

• Acute Care Admissions• Ambulatory Admissions• Emergency Department (ED)

Admissions

•Patient Admissions•Patient Registration/Scheduling

●Patient Admissions

• Patient Care• Physician Access• Clinician Access• Laboratory• Radiology• Pharmacy

•Clinical Document Access•Verbal Orders

●Clinical Departments• Accounts Payable

•Automated Invoice Processing•PO Matching•Vendor Inquiry• Invoice Approval•Travel & Expense

●Accounts Payable

• Health Information Management• Medical Records

• Medical Records (scanning and retrieval)

• Chart Deficiency Tracking• Coding Support• Release of Information• RAC Compliance• Chart Abstracting

●HIM• Human Resources

•Recruitment•On boarding•Employee/Manager Self Service•Employee Management•Physician Credentialing

• Patient claims• Patient Financial Services• Business office

•EOB Processing•835 Processing

●Patient Finance• EMR• EHR• HIS• Physician Portal• Departmental IS

•HL7•API/COM

●Clinical HIT Integration

• Legal• Compliance

•Contract Management•Retention Management

●Legal & Compliance

• Endowment• Foundation Auxiliary

•Gift Management

●Endowment

●Human Resources

Common Healthcare System ECM GoalsEnterprise‐Wide Document/Content Management Strategy including: 

• Existing and Planned System Integration Objectives

• Integration with EMR, Email and Key Operational/Financial Systems

• Back Office/Finance Objectives

• Improve back‐office processes, become “paper light”, reduce labor & storage requirements

• Technology infrastructure and processes to support mobile workers and collaborative workspaces

• Improve billing processes 

• Ambulatory Objectives

• Transition from paper to electronic charts – preferably without back scanning all charts

• Business process design to manage paper/documents outside of the electronic chart

• Hospital Objectives

• Develop document management strategy relative to the  current paper inpatient chart and convert  to electronic feeds to the EMR system/medical record where possible. 

• Eliminate the need for paper documentation.

• Business process design to manage paper and documents – processed outside of the electronic chart.  

• Improve clinical and operational collaboration  and costs enterprise‐wide.

The Challenges of ECM

Most organizations have a structured host application or multiple structured host applications.  These can be an ERP system like Peoplesoft, Lawson, etc. or an EMR or HIS system such as Cerner, Epic, etc. (including proprietary applications).  The key is that these systems manage and control data in a structured format i.e. files, records, db. 

However every day organizations receive crucial paper or electronic documents, emails, faxes, photos,  etc. that are related to these structured data (and to a specific patient or event) but are not directly linked to them.  

In fact, most businesses are still exchanging unstructured content.   As a result, they still spend billions on data entry, filing, searching for documents, copying, faxing and other forms of manual paper workflow.

The content with which an ECM strategy must contend can be broken down into two basic forms within an organization.  Structured & Unstructured. 

Information SilosStructured Data

Supporting Documents“Unstructured Data”

structured unstructuredstructured 83% of information is unstructured

Aortic Insufficiency

ECM Principles

Structured Data

Repository

Manage

CentralizedImaging

DistributedCapture

New Formsof Capture

IndexTransformStructure

Capture

Integrate

Print

WebDelivery

Deliver

DecisionSupport

TranslationInitiation

Unstructured Documents

ECM – The Opportunities

Patient Finance EOB Processing835 Processing

ClinicalClinical Document AccessVerbal OrdersRadiology Workflow Support

Back OfficeAccounts PayableHuman ResourcesPhysician CredentialingRecords Management

Clinical HIT & EMR Integration

Meditech McKesson Epic EclipsysCerner CustomSiemensMedseek

Patient Access Patient AdmissionsPatient Scheduling

HIMMedical RecordsChart Deficiency TrackingCoding SupportRelease of Information

Areas That Enterprise Content Management Can Impact

ECM Strategy & Workflow“Putting it all Together”

ECM – Workflow Optimization Examples

• Medical Record Completion – Reduces chart assembly activities and automates deficiency analysis through completion resulting in operational efficiencies

• ROI– Addresses HIPAA security and privacy ,Mobile or traveling workers who need to print confidential information while sharing print resources

• Chart Tracking – Supports “hybrid” or fully integrated medical record environment and simultaneous access.

• Patient & Physician Portal – Provides access to protected health information via the web

• Augment EMR/HIS – Seamless integration to existing HIS/EMR (e.g.  McKesson, Epic, Cerner, Meditech,  Allscripts, Perceptive, Hyland, etc.)

• Diagnostic Devices/Medical Imaging – Automates content capture, eliminates print/scan process

• Digital Photos/Surgery Videos – Provides central repository for storing and retrieving multiple types of content 

• Radiology PACS – DICOM

• Biometric Devices – Automated patient identification (e.g. fingerprint recognition, palm reading, retinal devices etc.) 

• Wave Devices – Automated ingestion via direct connection to modalities (e.g. EKG/EEG, Fetal Monitor Strips)

Health Information Management

Clinical Integrations

ECM – Workflow Optimization Examples

Patient Access• Paperless Registration – Stopping the paper up front • Patient ID – Provides version control for historical capture of patient identification (e.g. Drivers Licenses, 

Insurance Cards etc.)• Forms Automation/Signature Capture – Streamlines registration workflow• Hospital Generated content – Registration packets, consent forms, DNR, etc.Patient Accounting• RAC Administration Solution – Provides dashboard and detailed view of claims audit process• EDI Claims Processing/EOB Imaging/Processing – Streamlines & automated billing processes• Denials Management & Reconciliation – Automated processing, posting, and exception utilization through 

workflow

Administrative• Accounts Payable – Captures and integrates invoice processing • Human Resources – Automates Policy/Procedure distribution/tracking for meeting accreditation requirements• Medical Staff Credentialing – Automates capture/distribution of documentsAncillary Sites• Pharmacy Legal & Compliance• Laboratory Provider Contracting• Supply Chain/Central Supply Ambulance Services• Facilities Management Skilled Nursing Facilities

Revenue Cycle

Enterprise/Administrative/Back Office

Document Workflow: The whole pictureOptimization across the document lifecycle is critical given the business impact at every stage

Create

Store

AccessDeliver

Capture

Process

DocumentLifecycleSe

curity

Mobility

BPM/Workflow

Reliability

CustomerAcquisition / Retention

ComplianceHIPAA JCAHO

Cash Flow

Cycle‐times

Error Rates

Treatment Outcomes

Care‐giverProductivity

Cost / ROI

Length of Stay

Differentiation

DocumentingPerformance

Document Capture and WorkflowIntegration Options

Viewing Options

Capture Options

Email

scanned documents

inbound faxes

system reports/forms

electronic documents

print to “tiff”

Core Clinicals

windows viewer web viewer

Object Repository

web services

web services

file import automation

Advanced Clinicals

Patient Financial Services

Finance

Accounts Payable

Materials Management

Human Resources

Facilities Management

Legal

Contracts Management

Case Study: Patient Admissions

Patient Admissions

Document Management for Patient Admissions provides you with:

• Quick integration and rapid realization of ROI• Access to previously captured documentation, eliminating

the need to capture it again• Single-click access to needed documents• Ability to aggregate, group and route documents

Patient Admissions

Document Management for Patient Admissionshelps you:

• Standardize admissions processes• Accelerate the revenue cycle• Heighten access to information • Enhance patient safety and satisfaction• Speed admissions while ensuring accuracy• Save time and costs related to patient care and records

ABC Health System

ECM solutions help ABC Health System deliver exemplary care to 512,000 residents of Oregon and California. In patient admissions, ABC Health System improves the patient experience, reduces document loss and elevates productivity 

“By scanning a patient’s insurance card, they only have to show it once, and it’s the same with other key information. With this solution, the entire registration experience is faster, smoother and more streamlined.” 

Senior Programmer AnalystABC Health System

Simple, one‐time check in speeds care delivery and increases patient satisfaction

Routing admissions documents in the ECM Workflow speeds insurance verification, billing and other processes

Elimination of manual tasks boosts admissions associate productivity 

Minimized loss rate of patient documents 

Name: ABC Health SystemNumber of users: 1000+Integration: Siemens MedSeries 4, Misys, Intergy billing softwareDocuments Scanned Monthly: 280,000

CUSTOMER SUCCESS

TECH CORNER

Case Study: Chart Deficiency and Tracking

Chart Deficiency/Tracking

Document Management Solutions for Chart DeficiencyTracking helps you:

• Enhance HIM workflow• Speed chart completion • Reduce delays in revenue cycle• Bolster physician satisfaction by eliminating repeated calls for

information and the need for on-site signatures

Chart Deficiency/Tracking

Document Management for Chart Deficiency Trackingprovides you with:

• Tools to target and analyze deficient charts• Deficiency assignment and monitoring• Access from any location• Integration to the EMR• Secure digital signatures• Automated physician alerts and easy physician access• Concurrent access to document-related information

XYZ Health System

ECM solutions help XYZ Health System deliver exemplary care to residents in and around Tulsa, Oklahoma. By providing a common repository across facilities and applications, physicians have the information when they need it most.

“The ECM Repository has allowed us to integrate with multiple applications to provide seamless, one‐click access to those who need information immediately.

Senior IT ManagerXYZ Health System

Connecting the physician clinics and the hospital with single repository

Routing documents into the ECM Workflow speeds access to patient information

Elimination of copying or using courier service to move physical charts

Allowed physicians to access the same patient information at clinic or in hospital through different systems

Name: XYZ Health SystemNumber of users: 1000+Integration:MISYS, Allscripts,  GE IDX, SAP, Quadramed4, Documents Scanned Monthly: 450,000

CUSTOMER SUCCESS

TECH CORNER

The Approach: Current State Assessment

Process Practice

“What people say, what people do, and what they say they do are entirely different things.” ‐Margaret Mead

What people can tell you 

Workflows, task lists, procedures

Organization charts, cross‐disciplinary teams

Authorized descriptions of work

Often formal, documented

What people know (how to do), but don’t  (wouldn’t think to) talk about

Handling exceptions and contingencies

Informal networks, communities of practice

On the job learning, peripheral participation,  mutual monitoringOften informal, undocumented

Phase I: Operational Analysis

• Recommended performance metrics, data source definitions, and data flow to reports.• Documented current state processes and workflows.• Identification of gaps, risks, bottlenecks, compliance issues, etc.• Workflow‐critical software functionality descriptions (clinical and operational systems).• Recommended immediate changes for management attention.• Recommended Clinical and Business redesign project team members

Current State -> Future State Design

Participation

Document and tool analysis

On‐site open ended interviews Observation

Co‐designVideo Analysis

Get their “questions”, not their answers to your questions.

What they do is not the same as what they tell you

Artifacts for ordering, coordinating and representing work

Repeated, detailed, rigorous reviews

Experience the work first hand and put yourself in relationship with 

others

Facilitate practitioners to reflect on their practices, leverage their knowledge and make them feel that it is their own design

Phase II: Future Clinical/Business Operations

• Description of future Clinical and Business operations, including majorperformance objectives and problem resolution.

• A redesign team that understands the redesign direction and is solidly behindachieving future Clinical and Business operations and performance.

Phase III: Operations Redesign

• Documentation of redesigned Clinical and Business operational workflows for theidentified opportunity areas, noting specific software implications (EMR, ERP, other financial/operational systems) and multiple new designs where phased implementationwill be necessary.

• List of specific information needs to complete the detailed implementation plan andsequencing.

• A final report from Phases I, II, and III to be used as a reference and design guide throughout                   implementation and optimization along with expected ROI opportunities.

Look Familiar?

Very Similar to a LEAN Project Methodology

• Interestingly, roughly 45% of those organizations we’ve interviewed have seen their LEAN projects associated with workflows degrade back to a point closer to their pre-LEAN state within 18-24 months

• This is attributed to the fact that although the redesigned workflows were much more efficient their manual nature allowed them to be impacted by staff turnover and limited training on the purpose and structure of these workflows

• While those organizations using a workflow automation tool reported solid gains in place even 18 - 24 months later and many reported further enhancing workflows during this period

• Using an ECM/BPM tool to automate these workflows removes the training need and ensures that even a new employee can be involved in the workflow with no repercussions.

Questions?

If you have any additional comments/questions please contact:

Cathy Paich, Regional Vice PresidentXerox Healthcare Provider Solutions

Cathy.paich@xerox.com