The push for the adoption of electronic health records, especially the meaningful use of certified EHR technology as part of the EHR Incentive Programs, is based on the premise that the digitization of health information will led to more accurate, safer, and coordinated care. While EHR adoption will certainly lessen the role of paper records and documents in clinical settings, it will eliminate them altogether. Paper still floats around healthcare organizations and between providers. Paper documents came in from external sources. Patient registration forms require handwriting.
Legacy Health hospitals and clinics located in Portland, Ore., and Vancouver, Wash., just achieved the highest level of EMR adoption based on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) and its ambulatory version (A-EMRAM), Stage 7. While that designation signifies a paperless clinical environment, it doesn’t mean the end of paper at Legacy Health but rather sophisticate plan for integrating its Epic EMR with its enterprise content management (ECM) solution from Hyland Software, OnBase.
Last week, EHRintelligence.com caught up with John Kenagy, PhD, SVP/CIO of Legacy Health, to discuss the healthcare organization’s approach to integrate paper documents into the EHR system as well as strategies to extend this approach to other departments within the organization.
Why the need to integrate the Epic EMR and OnBase, the EHR and paper documents?
Legacy Health just achieved HIMSS EMRAM Stage 7, which is the highest level. In the strive for a paperless environment and to have all clinical decision-making empowered by online technology, inevitably there is still going to be some paper continuing to be generated by the healthcare system, whether that’s an outside record or patient-signed documents. We have less and less paper as we continue the Epic deployment, but invariably the process does generate some paper and the desire to not have a disrupted record — partial paper, partial online — to have everything online. The ability for clinicians to use Epic as the single portal and get everything, including scanned documents, fully integrated into Epic was our goal.
What are best practices for ensuring that the right documents become part of the right patient’s EHR?
We have a combination of some onsite scanning and others that are centrally done. In each of their units, there’s a basket for scanning that people in health information management will scour through twice a day. They will literally just go around like a sort of lab collection, bring that in, scan it, do quality assurance, and file into the record in the right place. The surveyor for HIMSS EMRAM Stage 7 specifically identified that as a positive in the evaluation of our status as fully EMR adopted.
Another best practice is even if it’s a departmentally-scanned form our central health information management department also does a QA on all of that scanning. That HIM department continued their professional practice and moving paper around (i.e., the manual part) has now been automated. It’s not that they’ve been automated out of a job; they were automated into a higher level of their thinking and management of health information. They weren’t fearful of the Epic EMR and OnBase because they knew it would change the nature of the job but actually allow them to work to the highest of their skill sets.
What infrastructure and other things are necessary to support this kind of environment?
Pictures of data take up much more storage than the data themselves, so you need to have a repository for that. It was all part of the co-design we did with OnBase from the very beginning. The important first step is choosing a vendor who really knows their business. We did that with Hyland. Then the process required sitting down and designing disaster recovery, backup, and other infrastructure premises. Next was the interface to Epic so that as something gets scanned in, it’s not that you go to a separate OnBase screen and you now have to re-pull up the patient and the document. It points directly to it. All of that integration and then testing and ensuring its reliability are why it’s not a short period from contract signing to full live. It’s a big task and it requires the level of quality we do for all electronic health record–type things.
Where else will scanning prove crucial to the organization’s health information management ?
There is a lot of paper throughout administrative processes and the like. Having a solution that can integrate into Epic and also Lawson, which is our enterprise resource planning platform, will prove to be a real benefit in the future. We certainly saw the capacity and bought an enterprise license. Legacy has already implemented electronic invoicing for accounts payable and is launching an effort to scan human resource files linked to Lawson HR.
