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Editor's Note: The introduction to our three-part package takes a big-picture look at how BPM is changing healthcare. Here, Part II focuses on BPM's growing role in the industry's long-time push to eliminate paper records. And Part III examines BPM's role in helping healthcare organizations with ever-tougher regulatory compliance.

A long-time push to eliminate paper is finally catching on in the healthcare industry.

Helped in large part by federal economic incentives, facilities such as hospitals, doctors' offices, skilled nursing facilities, hospices and clinics are seeking ways to replace those long rows of bulging patient folders with digital data that's both portable and well-protected.

Experts say the move to electronic health records (EHR)is long overdue—but not surprising, given that, on the whole, the healthcare industry has lagged significantly behind other fields in adopting new management processes designed to improve efficiency. But because of the sensitive nature of health records and the need for accuracy—calling this a matter of life and death is not an overstatement—the move to EHR should be a deliberately paced procedure rather than an as-soon-as-possible rush job, experts say.

"It's an ongoing remediation process. It's not one 'out-of-the-box' solution," says George Zimmerman, Internet administrator and webmaster for St. Peter's Health Care Services in Albany, N.Y., who's widely known an innovator in healthcare BPM. "You want to phase it in."


In 2009, about $35 billion in federal economic-stimulus money was earmarked to promote the adoption of electronic medical records, and there are substantial subsidies available for doctors who go digital: as much as $44,000 through Medicare and $63,750 through Medicaid.

Moreover, studies are now showing that EHRs improve clinical outcomes. For example, in September 2011, The New England Journal of Medicine reported that diabetics whose healthcare providers used EHR technology had better outcomes than those whose providers relied on paper records.

Many sectors have taken the electronic plunge; the MaineHealth consortium recently implemented a Shared Health Record system—the motto is "one patient, one record." That is a sea change for the healthcare industry: "The battle for years has been: 'I'm not giving you my patient information,'" Zimmerman says.

But there's no sugarcoating the expense: Costs can run into the hundreds of thousands of dollars. Zimmerman, who frequently speaks on how St. Peter's implemented its EHR system, says he is sometimes hard-pressed to validate expenditures from a pure dollars-and-cents perspective for his audience.

"They want to see you've invested $1 million and [can answer the question] 'How am I going to see that return?'" he says. "It's hard to put your finger on a number that financial folks and accountants love to see because the overall goal is to improve patient care or the patient's experience while at your facility."

But the move to EHR is both inevitable and desirable, says Sandra Nunn, who has directed health information management at three organizations and is the author of author of "Enterprise Content Management and the Electronic Health Record" (AHIMA Press, 2012). Electronic records allow all entities involved with patient care to access all information related to a particular patient—and that can be crucial as patient moves through the healthcare system.

"There's a period of vulnerability where the patient arrives at a new facility without information needed to care for patient," says Steven J. Spear, a senior fellow at the Institute for Healthcare Improvement and a senior lecturer at the MIT Sloan School of Management. "If a patient is acute or the information is slow in arriving, or too ambiguous, the patient is at risk."

Spear cited the case of his 90-year-old grandmother, who broke her hip and was transferred from a hospital to a nursing home, where doctors didn't realize she had been taken off the blood thinner Coumadin. The elderly woman wasn't a reliable source for information about her medications, and the doctors didn't understand the alarming swelling in her legs. Finally, someone on the medical staff realized that the patient was no longer taking Coumadinbhhnjh. "Information on what they did and why they did it wasn't captured and conveyed," Spear says.


Experts offer these guidelines for establishing or updating EHR systems:

Conduct an analysis. Thoroughly analyze the information that's now collected on paper or in disparate IT systems. Systems must be chosen "with lots and lots input from the clinic staff and what their processes are," Zimmerman says.

Plan for migration. Plan carefully for the migration of old documents into new systems, a costly and time-consuming process. Islands of scanned records are expensive and frequently disorganized, Nunn notes.

Think ahead. Implement a system capable of adding features and functionality over time.

Streamline utilization. You don't want to end up with 10 passwords for 10 systems. "Single sign-on has been a big secret of success for us," Zimmerman says.

Choose the right system. Choose a Web-based system in which access is not dependent on computers at every desk. This means, however, that you must also invest significantly in intrusion-detection systems, Zimmerman says.

Create systems that update in real time. Whenever a patient registers upon entering a facility, for example, that information should be immediately available to other departments.

Identify and distinguish between wants and needs. One department may want a calculator built into its record-keeping, but that may be both expensive and unnecessary. Another department may want 20-inch desk monitors; is that necessary for tasks such as using spreadsheets? "Bells and whistles may in no way improve patient care," Zimmerman says. The response to unnecessary requests should be along the lines of "'yes, it's nice, but we're not going do that until the needs are fulfilled,'" Zimmerman says.

Allow for staff improvement about improvements. "When you create a process with your employees, you walk out of the room and they immediately start changing it. Not because they don't want to do the work, but because they can start to figure out a better system," Nunn says.


Other issues to consider including having enough storage and back-up options for digital records and ensuring for the proper disposal of paper medical records. Zimmerman has seen stacks of sensitive documents tossed in a dumpster.

Some paper might be need to be retained. For example, Zimmerman says, while St. Peter's emergency-preparedness procedures and policies are stored on a portable server with battery backup, a paper binder with those procedures is also kept and routinely updated for extreme emergencies.

Patients also can play a role in eliminating paper. Rather than fill out forms on clipboards whenever they visit a doctor or clinic (paper that, experts say, is usually just tossed anyway), patients could input information at kiosks or even at home, saving time before they ever step into the examining room. Nunn is now working on the issue of interactive electronic consent forms, the crucial paperwork that's needed when patients agree to certain medical procedures.

Electronic health and medical records aren't yet perfect, Nunn says. But she predicts that, eventually, they'll be used through the U.S. healthcare system. She envisions a future in which a patient's sequenced genome will become part of his or her electronic health record, creating a resource for children and grandchildren.

About the Author

Based in the Boston area, Stephanie Schorow is a freelance journalist and book author. Contact her [at] sschorow@comcast.net.

More by Stephanie Schorow, ebizQ Contributor



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