UNLOCK SUBSTANTIAL SAVINGS FROM YOUR ELECTRONIC MEDICAL RECORD (EMR) TRANSITION

WHITE PAPER

CONTENTS

2 Introduction

3 Health Information Management In Canada

3 Addressing Information Governance in the EMR Transition

4 Why Are Patient Records so Costly and Challenging to Manage?

4 Eight Stages of EMR Implementation

5 Best Practices to Accelerate Your EMR Transition

6 Developing a Long-Term, Cost-Effective Transition Plan and Information Governance Structure

7 Getting Outside Help

7 Measuring the Results

7 Conclusion

WHITE PAPER

UNLOCK SUBSTANTIAL SAVINGS FROM YOUR ELECTRONIC MEDICAL RECORD TRANSITION

INTRODUCTION

Healthcare organizations in Canada spend billions of dollars annually to store and manage medical records — both paper and digital. The fact is the ever-expanding wealth of patient information has become an increasing strain on the Canadian healthcare system.

Many Canadian hospitals store their information across multiple vendors and in a hybrid state of physical and digital formats. Industry professionals have identified this as a driver of workflow and cost inefficiencies across the health information lifecycle. This paper examines how to unlock substantial savings by developing and implementing a cost-effective, EMR-ready infrastructure leveraging information governance (IG) best practices.

In 2014, total health spending in Canada amounted to $214.9 billion, representing 11 percent of Canada’s gross domestic product.1 Of that, hospital spending reached $63.5 billion, or 30 percent of total health spending.2 The federal government provides funds to provincial governments for healthcare services through programs such as the Canada Health Transfer (CHT). During fiscal 2014, the provinces received 32.1 billion through the CHT.3 Thus, there are national standards for hospital, diagnostic, and medical care services.4 Furthermore, implementing EMRs in Canada is a “pan-Canadian initiative that requires the collaboration of stakeholders, including the federal government, Canada Health Infoway Inc.,5 and the provincial and territorial governments, as well as other organizations involved in the delivery of healthcare.”6

The federal government offers financial assistance and incentives necessary for healthcare providers to begin the transition to electronic medical records, but cannot alone support the massive investment required to complete this migration. In addition, the complexity involved in integrating an EMR across multiple facilities in a health system — while still protecting the privacy of the patient data — is inherently challenging.

The good news is that addressing current workflow and cost inefficiencies will allow hospitals to reallocate resources to the EMR transition.

1https://www.cihi.ca/en/spending-and-health-workforce/spending2Ibid3https://www.fin.gc.ca/fedprov/mtp-eng.asp4http://www.pharmacists.ca/cpha-ca/assets/File/pharmacy-in-canada/Budget%202015%20-%20CPhA%20Overview.pdf

5 Notes: Canada Health Infoway was created in 2001 as an independent, not-for-profit organization that is funded by Canada’s federal government. “Infoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health solutions across Canada.” Source: https://www.infoway-inforoute.ca/en/about-us

6 http://www.oag-bvg.gc.ca/internet/English/parl_oag_201004_07_e_33720.html

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HEALTH INFORMATION MANAGEMENT IN CANADA

Research shows $436 million in savings to support push for health information management in Canada.

The Health Council of Canada and the Canadian Medical Association (CMA) issued a public statement calling for improved health information management across the country. The(CMA), proposed $423 million in funding for a five-year health information management plan for integrating electronic medical records within healthcare institutions across Canada.7

Subsequently, a major nonprofit healthcare organization in Canada released a study that showed electronic medical records will generate $436 million in savings and efficiencies for Canada’s entire healthcare system.8 The research supports the CMA’s prediction, which projected a 60 percent annual return on health information management investments once electronic medical records are fully installed.9

Information management providers will facilitate the switch to begin cutting costs, which the Canadian Institute for Health Information believes is important to get started on soon. The organization’s research found Canadian healthcare spent more than $180 billion last year and projects that number to substantially increase during the next few years.10

ADDRESSING INFORMATION GOVERNANCE IN THE EMR TRANSITION The healthcare industry is indisputably one of the most data-intensive industries in Canada. Yet modern dissemination and control of patient data continues to lag behind other industries such as banking, airlines, insurance, and retail. Despite this, healthcare organizations in Canada spend billions of dollars annually to store and manage medical records. However, without information governance, hospitals will continue to struggle to support the process of initial and ongoing EMR implementation.

In an article recently published in the Canadian Healthcare Technology magazine, Andrea Bacqué, Canadian Solutions Leader at Iron Mountain, explains that “in order to accelerate EMR adoption and reduce the reliance on paper, healthcare providers must come to terms with two fundamental concepts: (1) embracing a hybrid environment

in which paper and digital records coexist, and (2) addressing the shortcomings of legacy and paper record systems, including people, process, and technology.”

Bacqué also suggests leveraging a best-practice approach with the transition to the EMR and provides a Canadian model to learn from with a healthcare network comprised of three of the largest teaching hospitals in Québec. As Québec’s model proves, having a framework for governance that clearly defines goals and objectives is vital in the transition to the EMR. More importantly, however, goals of improving patient care through digital access to patient records must be shared among all key stakeholders. The full article is available at http://www.canhealth.com/emags/cht1505/index.html.

SELLING THE VALUE OF INFORMATION GOVERNANCE IG is an organization-wide framework for managing information throughout its lifecycle and supporting the organization’s strategy, operations, regulatory, legal, risk, and environmental requirements.

For health networks that have not yet started with an IG initiative, it is important to show how IG supports your organization’s top goals. For some health networks, value centers on potential cost and risk reductions. For others, value is seen as better use of the information to deliver patient care.

In communicating the value of IG, look for stakeholders throughout your organization who have found benefit in past information or paper-intensive workflow-improvement projects. The ability to share and communicate IG value builds the business case that can be used to gain further organizational buy-in.

SECURE SENIOR LEADERSHIP SPONSORSHIPA critical requirement in the formation and sustainability of an IG program is the sponsorship by an executive, preferably someone within or close to the C-suite. Depending on the size or political environment of your organization, sponsorship may come from the CEO, COO, CMIO, CFO, or CIO.

Executive sponsors provide direction, budget, and problem resolution. This senior executive position provides the level of advocacy needed to ensure that key goals are established and that the appropriate resources are assigned. This leader can also help to engage the right functions on an IG steering committee.

7 http://www.ironmountain.com/Knowledge-Center/Industry-News/Industry-News/R/Research-shows-436-million-in-savings-to-support-push-for-health-information-management-in-Canada.aspx.

8 Ibid9 Ibid10Ibid

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WHY ARE PATIENT RECORDS SO COSTLY AND CHALLENGING TO MANAGE?Healthcare providers are required to manage all of their patient information at every stage of its life — from creation to storage through destruction — while making that information available when needed and protecting it at all times. Even in the best of circumstances, healthcare records and information management presents an enormous challenge. It is an inherently difficult task to balance the information management challenges across multiple departments, multiple hospitals and healthcare organizations in a network, and thousands of patients, combined with the dueling needs to provide easy access and PIPEDA11-level security.

EIGHT STAGES OF EMR IMPLEMENTATIONIt is important to remember that not all hospitals and departments are on an equal level of EMR implementation. While some hospitals and large health networks are well underway with their EMR transition, many are still in the earlier stages. In addition to having an information governance strategy, the transition plan must take into account these different levels of automation.

Today, most departments are in transition because they have started or plan to start automating their workflow processes. These departments are in one of the eight stages of the Electronic Medical Record Adoption Model (EMRAM). (See chart below.)

EMRAM is an eight-stage process designed to support healthcare organizations and track the progress of their EMR adoption strategies. Each stage represents a certain level of functionality and deployment, and organizations cannot move to the next stage until all next-level criteria are met.

Notes:

*Based on the HIMSS Analytics Annual Study (Q4 2014), covering 641 hospitals across Canada.

**CPOE refers to an IT system wherein physicians directly enter medication orders into a computer system, which then transmits the order directly into the pharmacy.

Source: HIMSS Analytics Website

EMR ADOPTION IN CANADIAN HOSPITALS (%)* BY STAGES OF EMR IMPLEMENTATIONSTAGE DESCRIPTION Q4 2014

STAGE 0 The organization has not installed the EMR for all three major ancillary department systems — laboratory, pharmacy, and radiology.

19.0%

STAGE 1 The EMR is installed in all three major ancillary department systems. 14.4%

STAGE 2 The three key ancillary department systems feed data into a clinical data repository; hospitals can further share the data with other healthcare facilities through the health information exchange.

29.6%

STAGE 3 This stage includes the implementation of electronic medication administration record (EMAR) application for nursing/ clinical documentation, picture archive and communication systems (PACS) for access to medical images, and first level of clinical decision support for error-checking of each entry in the pharmacy information system.

31.7%

STAGE 4 This involves installing the computerized physician order entry (CPOE)** for use by any clinician licensed to issue medication orders, coupled with second-level clinical-decision-support capabilities.

3.9%

STAGE 5 This involves the integration of the EMAR and auto-identification technologies (barcodes, RFID, etc.) with CPOE and pharmacy systems to maximize medication-administration safely.

0.6%

STAGE 6 This involves the implementation of full physician documentation with structured templates and discrete data in at least one inpatient care service area for progress notes, consult notes, discharge summaries, etc. Further, level three of clinical-decision support is implemented, which provides guidance for all clinician activities regarding compliance protocols.

0.6%

STAGE 7 This stage reports the complete elimination of paper records, where hospitals use discrete data and medical and document images within their EMR environment.

0.2%

11 Personal Information Protection and Electronic Documents Act

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BEST PRACTICES TO ACCELERATE YOUR EMR TRANSITION

The world of Health Information Management (HIM) is rapidly changing as market and regulatory forces continue to drive the adoption of the electronic medical record. The biggest barrier to EMR adoption isn’t technology, funding, or the lack of understanding of the benefits.

Today, the biggest obstacle is adapting to newer workflows for delivering patient care in an EMR-enabled world. In other words, the biggest challenge is managing the change from a paper to a digital environment. Providers who take a comprehensive approach to balancing electronic and paper records can develop a holistic document management solution that promotes organizational acceptance and adoption of the EMR. As part of the transition to an EMR, providers should ask:

» What should be done with all of the existing paper records?

» How will clinicians cope with a fractured medical record scattered across the hospital or health network?

» How much more will it cost to manage dual record systems?

» Are there best practices for migrating paper records to electronic?

» How should legacy HIM processes be reengineered?

Many providers are already grappling with this new hybrid environment of records and are realizing the critical role information governance plays in terms of organizational change management in the transition to an EMR. These providers know that they can’t afford to spend millions of dollars upgrading an IT infrastructure to support an electronic environment — only to have the effort derailed due to lack of clinician and physician adoption.

Providers who transition to an EMR with a high degree of adoption will be those who manage the challenges of the hybrid environment.

Figure 1. A Healthcare Network Located in Quebec City. This network, comprised of three of the largest teaching hospitals in Quebec, aligned to an EMR transition. With shared goals of improving patient care through digital access to patient records, they also addressed workflow and cost-reduction objectives. The diagram illustrates the actual workflow and timing of patient record conversion.

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DEVELOPING A LONG-TERM, COST-EFFECTIVE TRANSITION PLAN AND INFORMATION GOVERNANCE STRUCTUREThe first step is to conduct a thorough, system-wide assessment of your records management program, including the RIM system. In considering these, it’s essential to get input from all the key stakeholders — from IT, Health Information Management, and Human Resources to department heads and senior executives.

The assessment should cover the gamut of records, including information processes that impact costs, care, and your organization’s goals. Following are areas that require investigation:

» Understand what you’re spending to manage your information, both where and why. Do you have multiple records storage vendors duplicating efforts — and costs?

» What are your true, total costs of records management across the organization? You should factor in real estate, personnel, vendors, etc.

» How will you handle hybrid records? You may want to utilize intelligent scanning where paper is captured as an image and an index is used to locate it.

» How will you manage the workflows and storage in the post-EMR environment to ensure continued cost control and efficiency maximization?

» How will you manage the explosive growth of digital data? Will you purchase capacity in advance of need, buying excess storage to compensate for system configuration and performance issues? Or will you look for a solution that maximizes capacity utilization, allowing you to scale on demand?

DESIGNING THE STRATEGYArmed with insight into current processes and costs, healthcare organizations can map out a plan of attack to eliminate waste and optimize processes.

The plan should be based on three key strategies:

» Consolidate and integrate health network records.

» Reengineer workflow processes that govern the management of records.

» Develop a digital storage plan to streamline the cost associated with digital archiving, backup, and recovery.

CONSOLIDATE AND INTEGRATE RECORDSWhile consolidation frees up capital to support the transition process, centralization builds a highly secure and compliant hybrid environment where paper records can

be easily converted to electronic medical records, if and when necessary. Centralization — meaning the transfer of all paper files, films, scanning, and release functions to a single provider — eliminates unnecessary vendor expenses and strengthens the chain of custody associated with records and information management. The ability to retrieve, process, scan, and deliver files from a central location reduces compliance risks and costs often encountered in fragmented systems. Moreover, the consistent application of workflow processes is more easily managed in a centralized system, ensuring continued cost-efficiencies in the post-EMR environment.

CLEAN UP MASTER PATIENT INDEX (MPI) DUPLICATIONSA closer look at the current state of the MPI clearly demonstrates the value of consolidation. The elimination of duplication is essential to the success of any EMR system. Managing duplicate medical records is not only costly, but it also leads to delayed patient care, as procedures and tests may be repeated unnecessarily, for example. To prepare for the EMR transition, hospitals should initially reengineer workflow to target lower ranges of medical record duplication.

REENGINEER WORKFLOW PROCESSESThe importance of reengineering and consolidating the manual processes of paper, film, and other records cannot be overstated. First, it reduces the workflow to a single coherent strategy upon which a successful EMR implementation can be built. This provides tremendous savings to large healthcare providers whose service area extends across different regions. Secondly, and just as importantly, the savings realized by reengineering can help pay for the costs of the technology needed during the initial EMR implementation and throughout the transition process.

DEVELOP A DIGITAL STORAGE PLANFinally, it’s important to note that technology and the savings associated with an EMR will not pay for the costs of the implementation on their own. As stated earlier, the number one financial drain on the current records management system is inefficient hard-copy storage. Similarly, the storage of digital files will result in increased storage costs if processes for streamlined digital archiving, reliable backup and recovery, and file retention are not identified and addressed early in the planning process.

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GETTING OUTSIDE HELPConsidering the importance of medical records to the core mission of patient care, most healthcare organizations will find it beneficial to partner with an outside expert to help plan, guide, and manage their records management strategy throughout the EMR transition.

It is essential to select a partner with specific expertise in healthcare records and information management who knows how to build an accurate financial model and manage an implementation with a full and detailed understanding of healthcare requirements and compliance regulations. This will free up internal resources and allow you to set goals and guide the project at an appropriate level — letting the experts manage the details.

Not only can outside vendors help during the initial implementation, but they can also provide guidance throughout the transition process. With their knowledge of best practices, they can save money, avoid costly missteps, and bring technology proficiency.

In virtually every health network, based on hard savings alone, the aggregate cost of a new, optimized records management strategy is less than the current cost of a dysfunctional system.

MEASURING THE RESULTSThe savings that a healthcare organization can realize from a planned EMR transition will depend on its individual circumstances. Therefore, the plan should spell out the expected savings so that decision makers will know exactly what to anticipate in terms of return on investment.

Correctly done, the process can fund itself based on the “hard savings” that are realized by optimizing records management. By hard savings, we mean real operational dollars spent on labor, storage vendors, purging costs, etc. The plan should be designed so that these direct savings are sufficient to undertake records optimization.

In practice, there are many “soft savings” that are realized as well, such as space savings, opportunity savings, cost avoidance, and so on. These savings make the case even better than it seems at first analysis. For example, if you replace an unneeded file room with a CT scanner, gift shop, or treatment room that generates services revenue, you have achieved serious soft savings.

In virtually every health network, based on hard savings alone, the aggregate cost of a new, optimized records management strategy is less than the current cost of a dysfunctional system. Since 2007, according to Canada Health Infoway, investments in electronic records, diagnostic imaging, drug information systems, and Telehealth have resulted in a total savings of approximately $9.1 billion12 for the Canadian healthcare sector. This is a result of improvements in the productivity of the systems that store and share medical records, which increases workflow efficiency and reduces test duplications.

In addition to the savings, the facility will have an EMR-ready workflow for its records, supporting the eventual move to a full EHR system. The transition plan focuses on reducing operational costs by changing workflows and centralizing or eliminating processes.

BEYOND THE TRANSITION: MANAGING RECORDS IN AN ELECTRONIC WORLDMost of the discussion surrounding medical records today is focused on the implementation and adoption of the EMR, and rightly so. However, it would be a mistake to assume that electronic records will end the issues of cost. Digital archiving, like paper storage, encompasses its own unique challenges and cost drivers. Without a predetermined, strategic transition plan, health networks will face increasing IT labor costs, frequent software and hardware upgrades, and, most importantly, increased data security risks.

One challenge facing healthcare IT organizations is the paradox that while the cost of storage is decreasing, the total cost to manage this storage is not. For the health network trying to archive increasingly large volumes of data, costs can spiral upward, not down. Simply put, storage volumes are growing faster than hardware prices are declining. Administrative costs go up, too, as the information volume grows.

CONCLUSIONThe challenges of an EMR transition are great, but so too are the opportunities. By addressing core issues, such as workflow and duplicate information as well as technology, healthcare providers can develop a strategy that can unlock substantial savings.

Further, by working with an expert partner, providers can look forward to a full digital solution that combines all forms of medical records in a practical clinical solution that controls costs while unburdening healthcare providers to focus more of their scarce resources on the mission of patient care.

For more information, contact Iron Mountain at 1.800.899.IRON (4766). For access to additional tools and insights, visit www.ironmountain.ca.

12 https://www.infoway-inforoute.ca/en

CA-HC-EXT-WP-070715-001 1.800.899.IRON | ironmountain.ca

ABOUT IRON MOUNTAINAbout Iron Mountain Iron Mountain Incorporated (NYSE: IRM) is a leading provider of storage and information management services. The company’s real estate network of over 67 million square feet across more than 1,000 facilities in 36 countries allows it to serve customers around the world. And its solutions for records management, data management, document management, data center management, and secure shredding help organizations to lower storage costs, comply with regulations, recover from disaster, and better use their information. Founded in 1951, Iron Mountain stores and protects billions of information assets, including business documents, backup tapes, electronic files, and medical data. Visit www.ironmountain.ca for more information.

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