Check out our Healthcare Information Management section for more information or to find companies that provide these products and services.

Despite the $27 billion in federal stimulus funds available to digitize healthcare records, paper isn't going to go away. That's why healthcare providers who consider EHRs as part of their overall information management strategy will be best positioned to meet the spirit of the Centers for Medicare and Medicaid Services' (CMS) "meaningful use" requirements. Document imaging and other enterprise content management (ECM) technologies will empower efforts to meet the reimbursement standards, while supporting the ultimate goal of improving long-term outcomes and provider efficiency.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), providers who demonstrate meaningful use of an EHR over a three-year period will collect reimbursements—assuming they meet the functional and quality measures (i.e., meaningful use) CMS has published. The first phase of the initiative is focused on capturing as much patient data as possible, and the second phase is centered on reporting on that data. The third and most important phase is to improve long-term outcomes for patients.

Meeting the goal of any of these phases will be difficult if providers can't account for the paper records. For instance, even before HITECH, patient health initiatives like health information exchanges (HIEs) and accountable care were growing. In to be successful, those programs require all documents related to a patient's care over a lifetime—not just the data entered into an EHR—using formats or protocols that can be easily shared and consolidated. Without converting existing paper-based records, it will be difficult to assemble a long-term health history for a patient. Because not all providers will be expected to implement EHRs at the same pace (some may even be excused, such as if they are near retirement age) these initiatives will be challenged by paper for years to come.

Meaningful use guidelines also slash the number of days providers have to deliver copies of medical records when a patient requests them to three; HIPAA guidelines allow 30 days. Meeting that new requirement will be significantly more challenging for health information management (HIM) departments and others who have to locate the physical documents.

Integrating ECM with Your EHR

According to industry analysts, providers using EHRs are still in the minority. However, among those that have implemented this technology, there are many examples of how integrated document management (IDM) complements the date-driven components of an EHR to build a comprehensive, highly accessible patient record. Both large and small health systems, for example, have been recognized with HIMSS Davies Awards for such projects.

In general, solutions for integrating document imaging and management into your EHR should be relatively invisible to users. ECM functionality is usually embedded directly into the EHR. A clinician should be able to select a scanning option directly from a patient encounter screen and immediately upload a document with little or no data entry. Existing documents relevant to patient care should also be available directly from the EHR application, even though they may be stored in an ECM repository.

Many EHR vendors offer document capture technology, like scanning, as part of their product line. Depending on your needs, that option may be adequate, but a thorough analysis of your current processes, resources, and volumes is in order. Make sure that the vendor can offer what you need, whether that's the ability to scan a few documents at the point of care, or thousands of documents daily in a centralized scanning facility.

The technology itself may also be an issue. Some EHR vendors have developed their own capture applications that may not have the maturity or functionality of a dedicated information capture product. In other cases, the EHR vendor bundles document capture functionality from another vendor, so you'll want to do some due diligence on that product to be sure it has the functionality and customer support you need. In either case, it is important to be able to retrieve the documents independent of the EHR and to ensure they are stored in a native format to support the interoperability needed to build HIEs or fully electronic release of information.

Even if your EHR vendor offers a document imaging and management component, it may be wise to compare it to ECM products that have a record of EHR integrations. In addition to meeting the HL7 support, auditing capabilities, and security requirements of patient records, these products may have the added advantage of being leveraged by other departments, allowing business units to share the cost of the ECM implementation.

Outsourced Scanning Services

For many providers, digitizing thousands or even millions of records is a massive undertaking and many may not have the resources, interest, or time to invest in such an operation. Outsourced scanning services are an excellent way to get new or existing patient records digitized quickly. Based on your space and comfort level, service providers may arrange for pickup and disposal of documents that need to be scanned; they may also set up an operation at your site, which still relieves you of the need to train employees and purchase expensive scanning hardware.

Regardless of where services are performed, outsourced document scanning services that specialize in healthcare will be able to provide you with HIPAA certifications, formal privacy policies, and information on employee screening procedures. An experienced vendor will also be able to provide consultation on how to prioritize records and how they should be classified based on your needs and best practices.

Additional Advantages

Most of the conversations around meaningful use center on reimbursements or the consequences of not implementing an EHR by 2014. Whether you run a small medical practice or an integrated delivery network, there are many worthwhile reasons to implement an advanced EHR strategy in addition to patient care:

• Studies show that patients want their records to be more accessible.
• Staffing and overtime costs are lower without compromising patient care when clinicians use a more advanced EHR, say analysts.
• Electronic records improve the revenue cycle by increasing availability of information needed for billing/exceptions in accounting as well as distributing charts for analysis, coding, and resolving deficiencies.
• Enterprise-class information management can extend beyond patient records to drive efficiencies across the organization, holding the line on IT cost and complexity.

It's true that you may be able to meet the minimum standards for meaningful use without an ECM solution to complete the EHR. But the vision for modernizing patient care won't be realized by doing the minimum.

Check out our Healthcare Information Management section for more information or to find companies that provide these products and services.