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Document Management is Good for Business
By Shubho Chatterjee, PhD, PE
Enterprise content management (ECM), also referred to as document management, is a capability with significant potential to centralize content and document storage, streamline and automate processes, and integrate smoothly with other enterprise systems. The business benefits are improved operational efficiency, reduced manual labor, reduced paper consumption, and improved process quality.
ECM consists of a central content or document repository, with indexing and searching capabilities, integrated with automated workflow allowing documents to be routed to appropriate processes and processors. The usage of the system is controlled by access policies at individual and group levels. Examples of use of this system include, but are not limited to, patient admissions, medical records management, invoice and payment processing, finance and accounts management, contract management.
A rigorous vendor selection process is critical to selecting the appropriate vendor. This should include an initial evaluation of functions and workflows where ECM is deemed to impact the most. Additional selection parameters include, but are not limited to, the total future cost of ownership for the proposed system, the projected process improvements and labor reductions, current material consumption, and current storage costs, product functionality, deployment options, and scalability. These parameters should be used to construct ROI scenarios for different options. Both objective and subjective factors should be integrated into the decision making.
Deployment options can be in-house (client server) or SaaS. While the in-house option provides for greater control, it also requires dedicated resources to manage, maintain, and upgrade the environment. SaaS deployment enables access to the system on a subscription basis with the vendor managing and operating the system and associated infrastructure in its data center.
The SaaS option frees IT staff to focus on more strategic tasks that add value to the organization while avoiding the expense of adding more IT infrastructure and resources to manage the system. Key factors to consider here are Internet connectivity and bandwidth and information security. Implementation is also quicker as the vendor completes the system build, configuration, and installation at their data center.
Collaborating to build a solution requires a thorough examination of the current processes across the organization with supporting process turnaround time data collection. This forms a baseline from which process improvements can be tracked in the future. To maximize the impact of the solution, this in-depth, step-by-step process analysis should be used to re-engineer and automate processes using ECM.
Creating efficiencies with this solution is feasible in many areas. After implementing ECM in the admissions department, Miami Jewish Health Systems has a central repository for patient documents. Seamless integration with the EMR application allows authorized users from any location to instantly access the associated patient’s documents from their workstation, eliminating time-consuming manual searches.
Routing documents electronically to employee’s workflow queues allows for faster processing and greater security. Eliminating the need to search for documents or make paper copies frees the admissions staff from tedious tasks and focus on patient care. Medical Records Management workflow has also improved with easy, instant, and effective collaboration across the organization. Medical personnel receive automated alerts for completing charts and associated notes and deficiencies. Previously, this required a visit to the medical records office.
Back-office departments, such as accounting and finance, have a high volume of paper flow and manual process being susceptible to lost invoices, missed bills, overpayment, or underpayment.
ECM deployment at MJHS is automating invoice processing. Invoices are now indexed to payments made and are searchable easily. With this technology, invoice approval is also automated and does not require manual inter-office mailing and completion. Payments are also completed in a timely manner.
As with any technology solution implementation, ECM must be well planned with a cross-functional team. Integration aspects with other enterprise applications must be well thought out. Baseline process documentation and re-engineered processes are also critical for success and before-after comparisons.
Shubho Chatterjee is chief information officer of Miami Jewish Health Systems of Miami, FL.
Regaining Control of Disaster Recovery
By Tony Cotterill
While working with our clients in hospital IT departments, we come across a variety of data backup scenarios. Some hospitals do full backups nightly, while others rely on an incremental/full backup strategy. Some sites exclude specific applications from their nightly backup simply because the volume is too great to complete in a 24-hour period.
Although there’s no ‘typical’ approach to backup and disaster recovery, a hospital’s data is a vital asset that must be protected. Before deciding how to protect it, however, first you must understand it.
The data landscape in the healthcare industry is more complex than in many other sectors, primarily because of the varied data types – namely, structured, unstructured and semi-structured — that are generated by both clinical and administrative systems. The type of data being secured and protected is inextricably linked to how that data needs to be recovered.
Structured data comes from database-driven applications, such as the hospital information system, radiology information system, electronic health record, and accounting systems. These applications typically generate hundreds of GBs, possibly a few TBs in larger facilities.
Unstructured data comes from applications that produce discrete files that are not associated with a database. Examples include word processing and spreadsheet files, which are routinely created by administrative staff and then stored on file servers. Many TBs of unstructured file data can be a challenge to backup and recovery.
Semi-structured data is produced most commonly by picture archiving and communication systems and document management and imaging systems. Both maintain a database of information (structured data) that references large quantities of discrete files (unstructured data). A PACS database may run on Oracle or SQL, and its size may be relatively small in relation to the many TB of DICOM images that database references.
Once you understand the three categories of hospital data, you can determine how much is dynamic vs. static. The dynamic data, which typically comprises 20-30 percent of overall healthcare information, is accessed regularly, and therefore changes constantly. This is the data you should be replicating every day.
Static data, which probably makes up the other 70-80 percent of your storage, should be treated differently. This unstructured and semi-structured data never changes and much of it will never be recalled again. Nevertheless, regulations and/or institutional policies compel hospitals to store it for five years, ten years, perhaps even the life of the patient.
So here’s the good news: once you’ve identified your static data, you can replicate it and move it to a self-protecting archive. Then there’s no need to include it in your backups.
This combination of backup and archiving provides an optimal strategy for treating each data type with the right method. By understanding the nature of the data in the critical clinical systems, the IT team can deliver both realistic and acceptable data recovery objectives to the business. In the event of a disaster, the organization can rest assured that the data can be recovered in a reasonable timeframe, minimizing the disruption to patient care.
Tony Cotterill is president and CEO of BridgeHead Software of Ashtead, Surrey, UK.
RTLS and Temperature Monitoring Mania
By Fed Up with the Fever
Would someone please tell me what real-time locating systems in healthcare have to do with environmental monitoring? I keep seeing all these temperature monitoring requirements pop up in RFPs and press releases. It concerns me that the healthcare CIO (or whoever is making these decisions) doesn’t realize that temperature monitoring of refrigerators has nothing to do with real-time locating, and even worse, is willing to saddle their wifi system with this function risking QOS-sensitive systems such as POE and VoIP.
Sure, real-time alerts of out-of-range or variable temperatures are important, but unless you’re subject to that old Bart Simpson joke where he calls up the bar and says, “Is your refrigerator running?” followed by Moe’s inevitable “Yes” and Bart’s “Well, then you better go catch it!” — well, your refrigerator is not mobile! There’s no need to locate it, and certainly not in real-time.
The real-time alerts and reports that healthcare needs related to temperatures of refrigeration units can be easily achieved with over-the-counter probes. Then, just as it would with any other DCC-based system (i.e., “dry contact closure” such as security cameras, alarms, doors, or nurse call lights), the RTLS would respond to certain pre-established conditions (i.e., temperature out of range). These other systems do not rely on real-time location except to “trigger” an event condition. That is, if you want a security camera to come on if a certain tagged piece of equipment enters the egress zone, you need the RTLS as it relates to the real-time location of the tagged piece of equipment.
Temperature monitoring requires no such “trigger.” It requires only that you “push” an alert to an individual (or group) when a particular event is recognized within the event software. No location changes are recognized or recorded. If healthcare organizations could recognize this, they would save a tremendous amount of money and not be subject to the heartache of a low-grade RTLS that does only one thing (wholly unrelated to real-time locating) well.
So I ask what RTLS has to do with temperature monitoring even as I understand why temperature monitoring is so prominent in the RTLS space. It’s an easy way for vendors to make money. So long as the company can write some basic rules, they can provide an alert when temperatures are out of range. They can also record temperatures at regularly scheduled intervals without staff ever having to physically approach the unit.
There’s no doubt it’s an important time and money saver for the hospital. And it’s a money maker for the RTLS vendor. They get to solve a problem for the customer and appear wholly competent on this level, so that when it comes to delivering their RTLS with any level of accuracy, there will be a certain level of trust pre-instilled.
Unfortunately, too many hospitals fall prey to the belief that environmental monitoring is a function of RTLS, so if the vendor can do that well, surely they can locate assets and automate patient flow, right? Sorry, folks, but it’s just not so.