Driving costs out of Healthcare FINAL(Modified) · Driving costs out of Healthcare in the Digital...
Transcript of Driving costs out of Healthcare FINAL(Modified) · Driving costs out of Healthcare in the Digital...
Driving costs out of Healthcarein the Digital Age
Cathy PaichRegional Vice PresidentXerox Healthcare Provider Solutions
Jim LeonardDirector of Healthcare Business DevelopmentGRM Document Management
Overview
Hospitals today need to efficiently process a myriad of diverse documents.
Even with the promise of increased automation and standardization brought about by industry dynamics and compliance with government mandates – the bulk of information exchanged today would still be categorized as “unstructured” and is destined to be around for many years to come.
The industry is now moving aggressively to capture and exchange this unstructured information (with appropriate linkage to structured data) to achieve a broad range of goals, including:
• Improving and automating workflows,
• Reducing costs,
• Increasing compliance, and
• Improving clinical and operational collaboration
The means to achieve this is via a comprehensive enterprise content management and business process management strategy (ECM/BPM).
This Requires a complete suite of components to integrate documents and workflows across the organization, both digital and paper, with advanced business process management tools.
What is Enterprise Content Management?Enterprise content management (ECM) and workflow tools enable hospitals to capture, manage, store, preserve and collaborate on important documents and information across the enterprise.
ECM and workflow tools seamlessly integrate existing MFD technology and existing clinical and financial applications – including Lawson, SAP, HIS and EMR platforms such as Cerner, Meditech and Epic.
These ECM tools support a hospital’s EMR and “paper‐lite” strategies by capturing and linking unstructured data (documents, faxes, etc.) with structured data.
Once a document is captured as an electronic image, it becomes a searchable, shareable resource that can be accessed from anywhere. Images can also be mined for their data in order to drive business transactions and improve and automate workflow.
Key Drivers ‐ Benefits: Process quality and efficiency – increased automation – productivityImproved data qualityImproved clinical/operational collaborationReduced costs Increased compliance & security (HIPAA, Meaningful Use, etc.)
ECM – The Opportunity
• Acute Care Admissions• Ambulatory Admissions• Emergency Department (ED)
Admissions
•Patient Admissions•Patient Registration/Scheduling
●Patient Admissions
• Patient Care• Physician Access• Clinician Access• Laboratory• Radiology• Pharmacy
•Clinical Document Access•Verbal Orders
●Clinical Departments• Accounts Payable
•Automated Invoice Processing•PO Matching•Vendor Inquiry• Invoice Approval•Travel & Expense
●Accounts Payable
• Health Information Management• Medical Records
• Medical Records (scanning and retrieval)
• Chart Deficiency Tracking• Coding Support• Release of Information• RAC Compliance• Chart Abstracting
●HIM• Human Resources
•Recruitment•On boarding•Employee/Manager Self Service•Employee Management•Physician Credentialing
• Patient claims• Patient Financial Services• Business office
•EOB Processing•835 Processing
●Patient Finance• EMR• EHR• HIS• Physician Portal• Departmental IS
•HL7•API/COM
●Clinical HIT Integration
• Legal• Compliance
•Contract Management•Retention Management
●Legal & Compliance
• Endowment• Foundation Auxiliary
•Gift Management
●Endowment
●Human Resources
Common Healthcare System ECM GoalsEnterprise‐Wide Document/Content Management Strategy including:
• Existing and Planned System Integration Objectives
• Integration with EMR, Email and Key Operational/Financial Systems
• Back Office/Finance Objectives
• Improve back‐office processes, become “paper light”, reduce labor & storage requirements
• Technology infrastructure and processes to support mobile workers and collaborative workspaces
• Improve billing processes
• Ambulatory Objectives
• Transition from paper to electronic charts – preferably without back scanning all charts
• Business process design to manage paper/documents outside of the electronic chart
• Hospital Objectives
• Develop document management strategy relative to the current paper inpatient chart and convert to electronic feeds to the EMR system/medical record where possible.
• Eliminate the need for paper documentation.
• Business process design to manage paper and documents – processed outside of the electronic chart.
• Improve clinical and operational collaboration and costs enterprise‐wide.
The Challenges of ECM
Most organizations have a structured host application or multiple structured host applications. These can be an ERP system like Peoplesoft, Lawson, etc. or an EMR or HIS system such as Cerner, Epic, etc. (including proprietary applications). The key is that these systems manage and control data in a structured format i.e. files, records, db.
However every day organizations receive crucial paper or electronic documents, emails, faxes, photos, etc. that are related to these structured data (and to a specific patient or event) but are not directly linked to them.
In fact, most businesses are still exchanging unstructured content. As a result, they still spend billions on data entry, filing, searching for documents, copying, faxing and other forms of manual paper workflow.
The content with which an ECM strategy must contend can be broken down into two basic forms within an organization. Structured & Unstructured.
Information SilosStructured Data
Supporting Documents“Unstructured Data”
structured unstructuredstructured 83% of information is unstructured
Aortic Insufficiency
ECM Principles
Structured Data
Repository
Manage
CentralizedImaging
DistributedCapture
New Formsof Capture
IndexTransformStructure
Capture
Integrate
WebDelivery
Deliver
DecisionSupport
TranslationInitiation
Unstructured Documents
ECM – The Opportunities
Patient Finance EOB Processing835 Processing
ClinicalClinical Document AccessVerbal OrdersRadiology Workflow Support
Back OfficeAccounts PayableHuman ResourcesPhysician CredentialingRecords Management
Clinical HIT & EMR Integration
Meditech McKesson Epic EclipsysCerner CustomSiemensMedseek
Patient Access Patient AdmissionsPatient Scheduling
HIMMedical RecordsChart Deficiency TrackingCoding SupportRelease of Information
Areas That Enterprise Content Management Can Impact
ECM Strategy & Workflow“Putting it all Together”
ECM – Workflow Optimization Examples
• Medical Record Completion – Reduces chart assembly activities and automates deficiency analysis through completion resulting in operational efficiencies
• ROI– Addresses HIPAA security and privacy ,Mobile or traveling workers who need to print confidential information while sharing print resources
• Chart Tracking – Supports “hybrid” or fully integrated medical record environment and simultaneous access.
• Patient & Physician Portal – Provides access to protected health information via the web
• Augment EMR/HIS – Seamless integration to existing HIS/EMR (e.g. McKesson, Epic, Cerner, Meditech, Allscripts, Perceptive, Hyland, etc.)
• Diagnostic Devices/Medical Imaging – Automates content capture, eliminates print/scan process
• Digital Photos/Surgery Videos – Provides central repository for storing and retrieving multiple types of content
• Radiology PACS – DICOM
• Biometric Devices – Automated patient identification (e.g. fingerprint recognition, palm reading, retinal devices etc.)
• Wave Devices – Automated ingestion via direct connection to modalities (e.g. EKG/EEG, Fetal Monitor Strips)
Health Information Management
Clinical Integrations
ECM – Workflow Optimization Examples
Patient Access• Paperless Registration – Stopping the paper up front • Patient ID – Provides version control for historical capture of patient identification (e.g. Drivers Licenses,
Insurance Cards etc.)• Forms Automation/Signature Capture – Streamlines registration workflow• Hospital Generated content – Registration packets, consent forms, DNR, etc.Patient Accounting• RAC Administration Solution – Provides dashboard and detailed view of claims audit process• EDI Claims Processing/EOB Imaging/Processing – Streamlines & automated billing processes• Denials Management & Reconciliation – Automated processing, posting, and exception utilization through
workflow
Administrative• Accounts Payable – Captures and integrates invoice processing • Human Resources – Automates Policy/Procedure distribution/tracking for meeting accreditation requirements• Medical Staff Credentialing – Automates capture/distribution of documentsAncillary Sites• Pharmacy Legal & Compliance• Laboratory Provider Contracting• Supply Chain/Central Supply Ambulance Services• Facilities Management Skilled Nursing Facilities
Revenue Cycle
Enterprise/Administrative/Back Office
Document Workflow: The whole pictureOptimization across the document lifecycle is critical given the business impact at every stage
Create
Store
AccessDeliver
Capture
Process
DocumentLifecycleSe
curity
Mobility
BPM/Workflow
Reliability
CustomerAcquisition / Retention
ComplianceHIPAA JCAHO
Cash Flow
Cycle‐times
Error Rates
Treatment Outcomes
Care‐giverProductivity
Cost / ROI
Length of Stay
Differentiation
DocumentingPerformance
Document Capture and WorkflowIntegration Options
Viewing Options
Capture Options
scanned documents
inbound faxes
system reports/forms
electronic documents
print to “tiff”
Core Clinicals
windows viewer web viewer
Object Repository
web services
web services
file import automation
Advanced Clinicals
Patient Financial Services
Finance
Accounts Payable
Materials Management
Human Resources
Facilities Management
Legal
Contracts Management
Case Study: Patient Admissions
Patient Admissions
Document Management for Patient Admissions provides you with:
• Quick integration and rapid realization of ROI• Access to previously captured documentation, eliminating
the need to capture it again• Single-click access to needed documents• Ability to aggregate, group and route documents
Patient Admissions
Document Management for Patient Admissionshelps you:
• Standardize admissions processes• Accelerate the revenue cycle• Heighten access to information • Enhance patient safety and satisfaction• Speed admissions while ensuring accuracy• Save time and costs related to patient care and records
ABC Health System
ECM solutions help ABC Health System deliver exemplary care to 512,000 residents of Oregon and California. In patient admissions, ABC Health System improves the patient experience, reduces document loss and elevates productivity
“By scanning a patient’s insurance card, they only have to show it once, and it’s the same with other key information. With this solution, the entire registration experience is faster, smoother and more streamlined.”
Senior Programmer AnalystABC Health System
Simple, one‐time check in speeds care delivery and increases patient satisfaction
Routing admissions documents in the ECM Workflow speeds insurance verification, billing and other processes
Elimination of manual tasks boosts admissions associate productivity
Minimized loss rate of patient documents
Name: ABC Health SystemNumber of users: 1000+Integration: Siemens MedSeries 4, Misys, Intergy billing softwareDocuments Scanned Monthly: 280,000
CUSTOMER SUCCESS
TECH CORNER
Case Study: Chart Deficiency and Tracking
Chart Deficiency/Tracking
Document Management Solutions for Chart DeficiencyTracking helps you:
• Enhance HIM workflow• Speed chart completion • Reduce delays in revenue cycle• Bolster physician satisfaction by eliminating repeated calls for
information and the need for on-site signatures
Chart Deficiency/Tracking
Document Management for Chart Deficiency Trackingprovides you with:
• Tools to target and analyze deficient charts• Deficiency assignment and monitoring• Access from any location• Integration to the EMR• Secure digital signatures• Automated physician alerts and easy physician access• Concurrent access to document-related information
XYZ Health System
ECM solutions help XYZ Health System deliver exemplary care to residents in and around Tulsa, Oklahoma. By providing a common repository across facilities and applications, physicians have the information when they need it most.
“The ECM Repository has allowed us to integrate with multiple applications to provide seamless, one‐click access to those who need information immediately.
Senior IT ManagerXYZ Health System
Connecting the physician clinics and the hospital with single repository
Routing documents into the ECM Workflow speeds access to patient information
Elimination of copying or using courier service to move physical charts
Allowed physicians to access the same patient information at clinic or in hospital through different systems
Name: XYZ Health SystemNumber of users: 1000+Integration:MISYS, Allscripts, GE IDX, SAP, Quadramed4, Documents Scanned Monthly: 450,000
CUSTOMER SUCCESS
TECH CORNER
The Approach: Current State Assessment
Process Practice
“What people say, what people do, and what they say they do are entirely different things.” ‐Margaret Mead
What people can tell you
Workflows, task lists, procedures
Organization charts, cross‐disciplinary teams
Authorized descriptions of work
Often formal, documented
What people know (how to do), but don’t (wouldn’t think to) talk about
Handling exceptions and contingencies
Informal networks, communities of practice
On the job learning, peripheral participation, mutual monitoringOften informal, undocumented
Phase I: Operational Analysis
• Recommended performance metrics, data source definitions, and data flow to reports.• Documented current state processes and workflows.• Identification of gaps, risks, bottlenecks, compliance issues, etc.• Workflow‐critical software functionality descriptions (clinical and operational systems).• Recommended immediate changes for management attention.• Recommended Clinical and Business redesign project team members
Current State -> Future State Design
Participation
Document and tool analysis
On‐site open ended interviews Observation
Co‐designVideo Analysis
Get their “questions”, not their answers to your questions.
What they do is not the same as what they tell you
Artifacts for ordering, coordinating and representing work
Repeated, detailed, rigorous reviews
Experience the work first hand and put yourself in relationship with
others
Facilitate practitioners to reflect on their practices, leverage their knowledge and make them feel that it is their own design
Phase II: Future Clinical/Business Operations
• Description of future Clinical and Business operations, including majorperformance objectives and problem resolution.
• A redesign team that understands the redesign direction and is solidly behindachieving future Clinical and Business operations and performance.
Phase III: Operations Redesign
• Documentation of redesigned Clinical and Business operational workflows for theidentified opportunity areas, noting specific software implications (EMR, ERP, other financial/operational systems) and multiple new designs where phased implementationwill be necessary.
• List of specific information needs to complete the detailed implementation plan andsequencing.
• A final report from Phases I, II, and III to be used as a reference and design guide throughout implementation and optimization along with expected ROI opportunities.
Look Familiar?
Very Similar to a LEAN Project Methodology
• Interestingly, roughly 45% of those organizations we’ve interviewed have seen their LEAN projects associated with workflows degrade back to a point closer to their pre-LEAN state within 18-24 months
• This is attributed to the fact that although the redesigned workflows were much more efficient their manual nature allowed them to be impacted by staff turnover and limited training on the purpose and structure of these workflows
• While those organizations using a workflow automation tool reported solid gains in place even 18 - 24 months later and many reported further enhancing workflows during this period
• Using an ECM/BPM tool to automate these workflows removes the training need and ensures that even a new employee can be involved in the workflow with no repercussions.
Questions?
If you have any additional comments/questions please contact:
Cathy Paich, Regional Vice PresidentXerox Healthcare Provider Solutions