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© Copyright 2008 American Health Information Management Association. All rights reserved.

Enterprise Content Management

Audio Seminar/Webinar May 20, 2008

Practical Tools for Seminar Learning

Disclaimer

AHIMA 2008 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

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The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

Faculty

AHIMA 2008 Audio Seminar Series ii

Susan deCathelineau, MS, RHIA

Susan deCathelineau serves as a Healthcare Industry Manager for Hyland Software, the Westlake, Ohio-based developer of OnBase. Susan’s primary responsibilities include developing business solutions for customers implementing Electronic Health Record (EHR) initiatives.

Susan, a Certified Document Imaging Architect (CDIA+) and ECM Practitioner, has more than 15 years of experience in managing hospital Health Information Departments, developing and implementing Health Information software as well as designing and supporting EHR solutions for healthcare organizations. Susan has received her Bachelor of Science degree in Health Information Management from the College of St. Scholastica and her Masters of Science degree from the College of St. Francis.

Prior to joining Hyland in 2006, Susan was the Corporate Information Services Manager for Allina Health System, located in Minneapolis, MN.

Understanding the complexities and opportunities involved in implementing an EHR solution, Susan has presented at multiple healthcare organizations as well as served on state and national AHIMA workgroups and currently serves as a member of the AHIMA EHR Practice Council.

Alan S. Goldberg, JD, LLM

Alan S. Goldberg is engaged in the practice of business and tax law including the delivery and regulation of health care, and information technology. From 1967 until 2006 Mr. Goldberg practiced law in the Washington, DC office of the Boston, New York, and London, UK law firm Goulston & Storrs - A Professional Corporation. In 2006 he opened the law office of Alan S. Goldberg, Attorney & Counsellor-at-Law in McLean, Virginia.

Mr. Goldberg received his AB in history from Brooklyn College of the City University of New York and his JD from Boston College Law School. Mr. Goldberg's introduction to health law occurred during the dawning of the Medicare/Medicaid programs era as a staff judge advocate, a District Claims Officer, and a prosecutor and defense counsel in the United States Navy from 1968 to 1970. Since 1967, Mr. Goldberg has practiced law, and served as adjunct faculty at universities including Boston University School of Law, University of Maryland School of Law, and George Mason University College of Health and Human Services, among others.

He is a Past President of the National Health Lawyers Association (1991-1992) and served on the American Health Lawyers Association Board of Directors from 1981 to 1993, and served as an Internet advisor to the AHLA Board. Mr. Goldberg received the AHLA David J. Greenburg Service Award in 1996 and was named an AHLA Inaugural Fellow in 2005, and received a distinguished alumnus award from Boston College Law School at the 75th anniversary celebration in 2006 of the founding of the law school. (Cont'd)

Faculty

AHIMA 2008 Audio Seminar Series iii

(Cont'd) Mr. Goldberg has authored publications on many business, health care, technology, and other legal issues including on topics relating to privacy and security, telemedicine, civil and criminal health care regulatory enforcement, ethics and professional responsibility, assisted living, and long term care development and financing. Mr. Goldberg plans and participates as a moderator and a lecturer in national conferences and teleconferences, including for the American Bar Association and the American Health Lawyers Association, and also for many other organizations across the U.S.

Mr. Goldberg is a member of the bars of the several states, and of federal courts including the bar of the United States Supreme Court. HealthLawyerBlog http://www.healthlawyer.typepad.com is Mr. Goldberg's educational weblog for health care students and for law students.

Table of Contents

AHIMA 2008 Audio Seminar Series

Disclaimer ..................................................................................................................... i Faculty .........................................................................................................................ii Polling Question 1 .......................................................................................................... 1 Learning Objectives........................................................................................................ 1 Overview....................................................................................................................... 2 Top Business Issues Facing Healthcare................................................................. 2 Reasons Why Patient Safety is Top IT Priority ....................................................... 3 Adoption Phases................................................................................................. 3 Content Sources................................................................................................. 4 Patient Registration ............................................................................................ 4 Registration Content Management ....................................................................... 5 Clinical Care....................................................................................................... 5 Clinical Care Content Management....................................................................... 6 Health Information Management ......................................................................... 6 Health Information Content Management ............................................................. 7 Revenue Cycle ................................................................................................... 7 Revenue Cycle Content Management ................................................................... 8 Administrative Departments ................................................................................ 8 Administrative Department Content Management.................................................. 9 Polling Question 2 .............................................................................................. 9 Case Studies.................................................................................................................10 Patient Care......................................................................................................10 Patient Safety Case Study ..................................................................................11 Revenue Cycle ..................................................................................................12 Revenue Cycle Case Study ............................................................................12-13 Compliance.......................................................................................................13 Compliance Case Study......................................................................................14 Q&A Session .....................................................................................................15 Implementation Considerations ......................................................................................15 Identify All Current Sources of Content................................................................16 Identify Legal Requirements...............................................................................16 Identify Gaps in Current Information Systems......................................................17 Storage and Retrieval Standards .........................................................................17 Document Retention Requirements .....................................................................18 Document Performance Requirements.................................................................18 Define Project Team Membership .......................................................................19 Enterprise Standard...........................................................................................19 Vendor Selection/Partnership..............................................................................20 Planning ...........................................................................................................20 Polling Question 3 .............................................................................................21 (CONTINUED)

Table of Contents

AHIMA 2008 Audio Seminar Series

Enterprise Content Management Success ........................................................................21 Q&A Session .....................................................................................................22 Resource/Reference List ................................................................................................22 Audience Questions.......................................................................................................23 Audio Seminar Discussion and Audio Seminar Information Online.................................23-24 Upcoming Audio Seminars ............................................................................................24 AHIMA Distance Education online courses .......................................................................25 Thank You/Evaluation Form and CE Certificate (Web Address) ..........................................25 Appendix ..................................................................................................................26 Resource/Reference List .......................................................................................27 CE Certificate Instructions


AHIMA 2008 Audio Seminar Series 1

Notes/Comments/Questions

Polling Question #1

Does your organization currently have a content management system? a) Yes b) No

1

Learning Objectives

Identify electronic documents encompassed in enterprise content management program. Understand how non traditional, clinical, and business documents should be incorporated into the enterprise content management program.Recognize challenges and concerns in enterprise content management.

2





Overview

3

Top Business Issues Facing Healthcare

*18th Annual HIMSS Leadership Survey

0%

10%

20%

30%

40%

50%

60%

70%

80%

Series1 69% 55% 52% 45% 38% 29%

Patient Safety Patient Satisfaction

Governmental Authority for

Cutbacks

Increasing Need for Health Care Services

Adoption of New

Technology

Avalibility/ Retention of

Clinical Staff

4




Reasons why Patient Safety is Top IT Priority

In 2000, the Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors.In nearly one in seven visits, [primary care clinicians] reported that clinical information important for the patients care was missing…Clinicians who reported having full [electronic medical records] were significantly less likely to report missing clinical information.A study found that 80% of medical errors began with miscommunication, missing or incorrect information about patients, or lack of access to patient records.

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Adoption Phases

Note: Moore's technology adoption curve

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Email

Web Pages

Enterprise Applications

Paper Documents & Files

Fax

Electronic Documents

FormsReports

Mail Graphics, Video, &

AudioBlueprints &

Photos

XML & Meta DataPrint Output

Health Level Seven

Content Sources


7

Patient Registration

Electronic Forms• HIPAA Privacy

Notices• Important Notice

from Medicare

Paperless Admitting• Driver’s License• Insurance Cards

Bedside Registration• Consent Forms• Physician Orders

8




Registration Content Management

Safeguards patient's identity to prevent and reduce lost revenue due to fraud

Improves registration workflow providing patient access efficiencies that create greater staff and customer satisfaction

Provides version control for identifying historical capture of patient identification such as driver’s license and insurance coverage

9

Lab Solutions• Lab System Integration• Reference Lab Workflow

Pharmacy • Pharmacy System Integration• Pharmacy Workflow

Radiology • Cardiology/EKG Integration• PACS/DICOM Integration

Electronic Medical Record• Hospital Based• Physician Based• Ambulatory Surgery• Emergency Department• Home Health• Long Term Care

Clinical Care

10




Clinical Care Content Management

Timely access to the patient’s medical record enhancing quality of patient care and improving patient safety by ensuring continuity of patient management among healthcare providersReduces need to transport paper records between separate geographical areas to access patient information, reducing labor and associated costsProvides central location for storing and retrieving multiple type of content in creating the electronic health record

11

Content Capture• High volume/ batch

scanning• Fax server

Integration

Medical Records Management• Deficiency

Management• Integrated Physician

Completion

Release of Information

Health Information Management

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Health Information Content Management

Reduces or eliminates chart assembly activities resulting in operational efficiencies

Reduces file management and storage resulting in significant savings on file storage and potentially dedicating more physical space to patient care areas

Enables electronically signatures improving turnaround time for record completion by streamlining services to healthcare providers

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Coding Workflow• Remote Coding • Automated Work Routing

EDI Claims Processing• 835 Processor• 837 Processor

Paper EOB Imaging/Processing• Payment Posting from Image• Advanced Optical Character

Recognition (OCR)

Automated Secondary Billing

Denials Management Workflow

Revenue Cycle

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Revenue Cycle Content Management

Streamlines revenue cycle process by making information readily available for coding and abstracting resulting in improved accounts receivables processing time

Allows for implementation of remote coding and facilitates review process by DRG coordinators to ensure accuracy of coding

Promotes accurate reimbursement and better accounts receivable management

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Accounts Payable• Invoice Processing

Human Resources• Policy/Procedure

Distribution

Legal/Contract Management/ Compliance

Materials Management

Administrative Departments

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Administrative Department Content Management

Human Resources• Recruiting • Orientation• Performance Evaluations• Payroll / Benefits

Accounts Payable• Invoices• Checks• Vendor Contracts• Purchase Orders

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Polling Question #2

If you have a content management system, in which area is it deployed? a) Registrationb) Clinical Carec) Health Information Managementd) Revenue Cyclee) Administrative Departmentsf) All of the above

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Case Studies

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Patient Care

Business Priorities:

Patient SafetyDecrease in Medical ErrorsIncrease in Patient Satisfaction

Patient InformationComplete patient documentationInformation available at point of care

ECM Solutions:

Complete the EMRAssimilates informationin a central repositoryConnects multipledepartment systemsand processes

Results:Increased efficiency andadvanced workflowPhysicians spend moretime with patients and less time on administrative tasks

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Patient Safety Case Study

Organization Description:• An integrated clinic and hospital system • Serving nearly two million people a year across the

region • Service area spans 250 miles with over 40 locations

Critical Issue: Patient health records that were difficult to collect electronicallyReasons: The current Electronic Medical Record system could not meet the priorities identified by healthcare leaders in providing patient care such as capturing paper and handwritten documents.Capabilities needed: The organization needed to enhance patient care, improve business processes and connect disparate information systems. In addition, there was a need to address gaps in data centric applications and to consolidate patient information throughout the patient care delivery cycle.

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Patient Safety Case Study (cont’d)

Results: Patients and physicians have seen increased efficiency and advanced work processes Physicians spend more time with patients and less time on administrative tasks Incomplete records are less than 30 percent, down from nearly 50 percent, and analyst productivity has increased by 40 percent

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Revenue Cycle


Cash FlowDecrease in AccountsReceivable daysIncrease in cash collections

Efficient Billing CycleAccessible and accurate patient registrationinformation Electronic claimssubmission

ECM Solutions:

Paperless Registrationand Claims Submission

Electronic patientdocument and signaturecaptureEDI claims submissionBilling system integration

Results:Eliminates redundant capture of informationIncreases productivityand cash flow

23

Revenue Cycle Case Study

Organization Description:• Over 70 ambulatory clinics• 2 hospitals (450+ beds)

Critical Issue: Managing paper-based patient documents that originate outside of the Electronic Medical Record (insurance information)Reasons: With a paper system, patient registration information had to be delivered from one location to another. If appointments were closely booked, the paper documents may not be filed to the paper chart in time for the second visit. Capabilities needed: The organization needed to share documents across multiple sites to reduce manual labor and increase patient safety. These sites included over 100 patient registration locations and over 200 users who needed to research patient information for claims submission.

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Revenue Cycle Case Study (cont’d)

Results:

• Eliminates redundant collection of patient documents

• Makes important patient care information available quickly to multiple caregivers

• Supports research for Patient Financial Services, increasing productivity and cash flow

• Reduces risks and costs associated with managing and transporting paper documents

25

Compliance


Joint Commission Accreditation

Accreditation complianceEmployee education

Policy and ProceduresDistribution of policy/procedures Validation of employeereceipt of policy/proceduresDocumentationstored in central location

ECM Solutions:

Document KnowledgeTransfer

Reduces labor requiredfor maintaining paper-based filesProvides secure access to documents making it possible to respond to manager and employee inquiries

Results:Joint Commissioncompliance

26




Compliance Case Study

Organization Description:• Over 70 ambulatory clinics• 11 hospital locations

Critical Issue: Approximately 23,000 people employed across nearly 20 business units, each operating semi-independently. Reasons: As part of a system-wide Human Resources re-design initiative, improved access was required for employee personnel and benefit documents, in responding to employee inquiries and facilitating Joint Commission surveys.Capabilities needed: The organization needed a fully integrated solution that provided document imaging and management, automated workflow and records retention, making it possible for the corporate HR department to share documents across multiple locations.

27

Compliance Case Study (cont’d)

Results: • Decreased response

times to employee requests by an estimated 50 percent.

• Proven ability to facilitate Joint Commission compliance

• Maintains productivity by making files available to multiple authorized employees

• Reduces labor requirements for maintaining paper-based files

“Just personnel and benefits documents amount to an estimated 3.5 million pieces. The files and file space were growing, and square-foot costs are very high in a hospital. Our mission to put patients first was not supported by adding more filing cabinets.”

Director of Human Resources

28




Q&A Session…

Topic: Enterprise Content Management Overview/Case Studies

To ask a question:

• Click the “Q&A” button near the upper-left• Click “NEW”• Type your question in the white box• Click “SEND”

(For LIVE seminar only)29


Implementation Considerations

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Identify all Current Sources of Content

1/1/20061/1/2003System 2EPathology Reports

7/1/2006System 1ECare Flow Sheets

7/1/2005System 3ERadiology Reports

1/1/20071/1/2004System 1EDischarge Summary

PProgress Notes

PPhysician Orders

1/1/20071/1/2004System 1P/EHistory & Physical

Stop Printing

Start Date

Electronic Storage

Start Date

Source System

Application (non-paper)

Media Type

(Paper/Electronic)

Report/Document

Type

Identify Legal Requirements

State Regulations

Accreditation Standards

HIPAA Privacy and Security

Conditions of Participation

Professional Peers

32




Identify Gaps in Current Information Systems

Document Matrix• Identify where and how specific document types are

generated• Update matrix as new document types are identified

Data Map• Develop a comprehensive data map of all organizational

workflows• Re-engineer and redevelop workflows as appropriate

Process Development• Identify paper and manual processes impacted by moving

to an electronic medical record• Develop comprehensive processes and procedures that

address the conversion of paper-based documents to an electronic form

33

Storage and Retrieval Standards

Define access requirements• Patient access to health records• Clinical access to protected health information• Release of information

Define retention requirements• Create approved retention schedule that must apply to

all paper and electronic health records• Include the retention schedule of the metadata and

audit trails

Define performance requirements• System response time• System availability

34




Document Retention Requirements

Retention Trigger• Implement document management system capable of notifying

the user with a retention trigger (such as ten years from filingdate, upon completion of the case, or expiration plus three years)

Selective Destruction• Use a process of selective destruction in which some types of

documentation can be retained while other documentation can be destroyed

• Policy for record retention and destruction of medical record documentation should be based on the type of document

• Once the statute of limitations has expired on an episode of care, it then is possible for document to be destroyed

• Every type of document should be evaluated individually for retention, recognizing that not all documents have the same need for retention

35

Define Performance Requirements

Compatibility • Determine whether existing hardware and software

external to the EMR system are compatible with the proposed platform and software

Down-time• Document system down time for back-up, upgrade, and

disaster-recovery processes

System Back-ups• Define acceptable times for system backups and

upgrades and ensure that staff is aware of down-time procedures

Disaster Recovery• Participate in regular disaster-recovery process testing to

ensure that data recovered are complete and accurate36




Define Project Team Membership

Operations• Form an executive-level committee and obtain

executive-level support • Form an organizational-level committee• Address the change in culture for going paperless

Information Technology• If you are going paperless in several different

systems (e.g., radiology, physician order entry), evaluate hardware needs in each department to ensure that all staff can access the system as appropriate to their job functions

Clinical Services• HIM professionals can provide invaluable insight for

the clinical team in assisting it to consider all issues affecting the clinical workflow and going paperless

37

Enterprise Standard

Thought Leadership• Transition from a paper-based health record to an

electronic medical record environment must be addressed and managed on many different and complex levels: • Administratively• Financially• Culturally

• Most organizations will not make the transition from a paper-based environment to an electronic environment in one quick and easy step

• Project will evolve over many years, requiring many change-management dynamics

Measurement of Success• Physician Adoption• Medical Record Access – turnaround time• FTE re-deployment 38




Vendor Selection/Partnership

Establish selection committee made up of 3 distinct user groups• Revenue Cycle • Clinical• Other (Legal, Accounts Payable)

Establish criteria for selection process

Customer base includes Health Care organizations

Integration capabilities39

Planning

Project Definition/Scope• Review and revise your organization’s legal health

record policy• Create a comprehensive policy that describes each step

involved in the transition to a paperless environment

Project Timeline• Develop a comprehensive plan of actions and

milestones • Detail each step involved in the move to a fully

electronic system• Detail a definitive date for the completion of the

migration • Detail individual departmental or divisional rollout

dates40




Polling Question #3

What challenges have you experienced or do you foresee in implementing an ECM solution? a) End User Adoptionb) Business Line Integrationc) Standardizationd) System Performancee) All of the above

41

Enterprise Content Management Success

ClinicalCare

Pharmacy

FacilitiesManagement

Lab AmbulatorySurgery

PhysicianOffice

HumanResources

Health Information

AmbulanceServices

MedicalImaging

EmergencyDepartment

Registration

PatientFinancialServices

AccountsPayable

Legal

Coding

Home Care/Hospice

42




Q&A Session…

Topic: Enterprise Content Management Implementation

Considerations

To ask a question:

• Click the “Q&A” button near the upper-left• Click “NEW”• Type your question in the white box• Click “SEND”

(For LIVE seminar only)43

Resource/Reference List

• To Err is Human: Building a Safer Health System, Institute of Medicine 2000

• Missing Clinical Information During Primary Care Visits, The Journal of the American Medical Association, February 2005

• A string of Mistakes: The importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors, Annals of Family Medicine 2004

• Document Management Practice Brief – AHIMA

• 18th Annual HIMSS Leadership Survey

44




Audience Questions

Audio Seminar Discussion

Following today’s live seminarAvailable to AHIMA members at

www.AHIMA.org“Members Only” Communities of Practice (CoP)

AHIMA Member ID number and password required

Join the e-HIM Community from your Personal Page. Look under Community Discussions for the Audio Seminar Forum

You will be able to:• discuss seminar topics • network with other AHIMA members • enhance your learning experience




AHIMA Audio Seminars and Webinars

Visit our Web site http://campus.AHIMA.orgfor information on the 2008 seminar schedule. While online, you can also register for seminars and webinars or order CDs and Webcasts of past seminars.

Upcoming Webinars

Fundamentals of e-DiscoveryJune 10, 2008

Release of Information: The Nuts and BoltsJune 24, 2008

The Legal Health Record: The Legal Hold ProcessAugust 12, 2008




AHIMA Distance Education

Anyone interested in learning more about e-HIM® should consider one of AHIMA’s web-based training courses.

For more information visit http://campus.ahima.org

Thank you for joining us today!

Remember − visit the AHIMA Audio Seminars/Webinars Web site to complete your evaluation form and receive your CE Certificate online at:

http://campus.ahima.org/audio/2008seminars.html

Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate.

Certificates will be awarded for AHIMA CEUs.

Appendix


Resource/Reference List .......................................................................................27 CE Certificate Instructions

Appendix


Resource/Reference List To Err is Human: Building a Safer Health System, Institute of Medicine 2000

Missing Clinical Information During Primary Care Visits, The Journal of the American Medical Association, February 2005

A string of Mistakes: The importance of Cascade Analysis in Describing, Counting, and Preventing Medical Errors, Annals of Family Medicine 2004

Document Management Practice Brief – AHIMA "Electronic Document Management as a Component of the Electronic Health Record" http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_021594.hcsp

18th Annual HIMSS Leadership Survey

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CE Certificate

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You will be automatically linked to the

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