6 optimization strategies for electronic document management systems

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6 Optimization Strategies for Electronic Document Management Systems

Section 6.9 Optimize

Optimization Strategies for

Electronic Document Management SystemsMany health care facilities preparing to adopt an electronic health record (EHR) have paper-based records for those they have treated. As part of your chart conversion and pre-load planning, you will need to determine whether to keep the paper records, scan all of these records, scan only records for active clients, or scan only parts of active clients records. Understanding the options for scanning and other forms of document managementand preparing to use such systemshelps manage the scanning process and supports use of the scanned record content.Time needed: 4 6 hours

Suggested other tools: Section 2.4 Visioning, Goal Setting, and Strategic Planning for EHR and HIE, Section 2.6 Workflow and Process Redesign for EHR and HIE, Section 2.13 Chart Conversion and Pre-Load Planning

How to Use

1. Review your chart conversion and pre-load planning to determine the potential size and nature of your scanning project.

2. Review the types of electronic document management systems (EDMS) to determine which type is most suitable for your facility.

3. Develop a plan for implementing EDMS.Types of EDMS

Different types of EDMS provide a continuum of features and functions, from simple to sophisticated. The following are the types of EDMS used most frequently in health care: Document scanning is performed using a scanner with scanning software that scans the document and enables it to be moved into a folder on a computer. The individual performing the scanning saves the scanned image of the document as a file and then saves it to an appropriate folder. This approach is satisfactory for occasional scanning, but is too time consuming for scanning health records in bulk (such as for scanning all archived records). Each document in a record could take 15 to 30 seconds to prepare, 15 to 30 seconds to scan, and 30 seconds to a minute or more to index (for a total of one to three minutes per page).

Electronic document management systems (EDMS) help manage the indexing and filing of documents. This type of system is used for bulk scanning to archive and occasionally to retrieve scanned records. It is the most common form of scanning in health care. Within EDMS there are various levels of functionality: Basic indexing support is achievable using more sophisticated software that supports reading a leading separator sheet and sub-header separator sheets for each type of document (e.g., notes and orders) placed throughout the set of documents or record.

Automated indexing support use barcodes placed on each document that designates who the record belongs to and the type of document. Barcoded labels can be run for each record to be placed on a document. Labels can also be acquired to designate type of document or forms can be printed with the barcode designating the type of document so only names needs to be added. Software places each of the documents that are scanned into the appropriate folder and arranges the documents according to type. If the date each document was created is on the barcode label, the documents can be filed in date order within their type. Optical character recognition can also be used for indexing. The more indexing incorporated, the more time it takes to prepare the documents for scanning, but the easier they are to retrieve later.

Electronic feed of documents is a feature of EDMS that is important if your health professionals use dictation, receive electronic faxes (e-faxes), and/or receive email that need to be incorporated into your EHR. The ability to transmit the voice file, transcribed document, e-fax, or email directly to the EHR is a significant time saver rather. Alternatively, you have to print these out and scan them back into your system. In the past this functionality was referred to as computer-output to laser disk feed (COLD-feed). Today most of the electronic feeding of documents is performed on magnetic disks, but you may continue to hear references to COLD-feeding.

Workflow support is another feature of document management software. This enables the facility to set up rules for processing various documents. The software alerts a staff member to retrieve documents designated for a specific type of processing. For example, if certain documents should be directed to a person who assigns diagnosis and procedure codes for billing purposes, the workflow software directs that person to the applicable records. Workflow support is very useful if document scanning is the primary means of storing active records. More commonly, the EHR itself provides workflow support. Electronic content management system (ECMS) incorporates the above-described functionality and also is able to designate content to be read and processed by the computer. There are two ways to achieve this. On a text document that will be scanned, a few items of content may be designated with a barcode or optical character recognition to be extracted by the computer for subsequent processing. For example, if you wish to run a report on most frequent condition treated, the most frequent condition (or diagnosis code) would be extracted by the computer. More often, an e-form is used in ECMS. This allows extraction of data from the entire form for collection and processing by the computer. The e-form may include a mix of barcodes, optical character recognition, object mark recognition (bubble forms), and intelligent character recognition/handwriting recognition and/or speech recognition.

ECMS can be very useful when coupled with an EHR. For example, you could ask an individual to complete an e-form questionnaire in the waiting room. The questionnaire is then scanned, making the data readily accessible in the EHR. For this to be achieved, the ECMS software must be compatible with EHR interoperability standards, especially Health Level Seven (HL7). (See Section 1.3 Interoperability for EHR and HIE). Increasingly, tablets are replacing e-forms; the individual in the waiting room would be handed a tablet on which to complete the questionnaire, which would be designed as a special template within the EHR. Access to other parts of the EHR would be restricted through security controls. Enterprise content, collaboration, and communications management systems are not commonly used to support health care services, but can be helpful for business purposes. For example, when several individuals are contributing to the development of a document, enterprise content, collaboration, and communications management aids in version control and enables all parties to interact simultaneously as the document is being created.

In addition to different types of scanning software systems, there are image formats that result from the scanning process. The four most common are:

.PNG is suitable for text images or detailed drawings. There is no loss of image data when the image is scanned. PNG files can be very large, reducing the time it takes to retrieve them.

.JPG is a good choice for digital photos and other colorful images. This format compresses the size of these files, making them smaller and faster to access than PNG images, although there is a slight loss of image quality.

.TIF overcomes the loss of quality in the JPG file format while still compressing the size of the file. These images are also versatile because you are able to apply data tags, resulting in ECMS capability. However, these tags are not standardized so they are compatible only with the software that created the imageand not compatible with EHRs.

.PDF is probably the best choice for text documents. Some programs, such as Adobe Acrobat, use optical character recognition technology to scan text characters of the text. You can edit the text later and search for words or phrases in the document. Adobe Acrobat can also be used to create templates that can be filled in or to affix an electronic signature to the document. Since the PDF format includes automatic image compression, it is a satisfactory choice for scanning images.

The PDF file format is the most standardized, in that anyone with any computer can retrieve and use a PDF file with a (freely available) reader. However, this process does not incorporate the content of the PDF file into an EHR. To do so, the PDF file must be transported to the EHR (from the scanning software or other source of the PDF) as an attachment to an HL7 message. The transporting mechanism would provide information on how the PDF file should be indexed and where it should be filed, as well as how the PDF document is made known to the user.Finally, there are different types of scanners and other associated equipment: Flat-bed scanners scan one sheet of paper one at a time. They are not satisfactory for bulk scanning, but are useful for scanning objects such as insurance cards, drivers licenses, pages from a book, etc. Different sizes are available. If only small items are to be scanned, a small scanner can easily fit on a desk.

Sheet-feed scanners automatically scan multiple pages, one after the other. They are most suitable for bulk scanningalthough staples, sticky labels, and odd-size forms will not go through these scanners.). Different sizes are available. If you plan to scan records routinely, it would be appropriate to acquire a sheet-feed scanner that is heavy-duty enough to withstand a lot of scanning. However, if you plan to scan all archived records and then only scan occasional documents, it may be suitable to lease a large-scale sheet-feed scanner for the archived record scanning project and then buy a flat-bed scanner for occasional use.

Dual-monitor workstations often are used in large-scale scanning operation

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