When paperwork doesn't work

October 1, 2006

There is a growing records management crisis in the world of healthcare. Hospitals are awash with paperwork, as legal, payer and regulatory requirements steadily generate an increasing number of documents per patient visit. Unfortunately, most healthcare information technology (HIT) systems are wholly inadequate to meet these growing documentation requirements.

There is a growing records management crisis in the world of healthcare. Hospitals are awash with paperwork, as legal, payer and regulatory requirements steadily generate an increasing number of documents per patient visit. Unfortunately, most healthcare information technology (HIT) systems are wholly inadequate to meet these growing documentation requirements.

While robust solutions are used to support certain clinical and administrative functions, most IT infrastructure within hospitals is ill equipped to deal with the documentation support requirements of today's healthcare environment. In fact, many are paper-oriented systems that are slow and prone to errors and add significant cost, waste and inefficiency in the healthcare enterprise.

Almost all of these information systems, whether paper based or electronic, exist in isolated silos that cannot easily integrate and communicate with other systems or the larger hospital IT infrastructure. The laboratory system has its own database; the admitting system has its own application; and patient accounting yet another. There is literally a different system supporting each functional area within the healthcare enterprise

The average nationwide cost of creating a paper chart is $8. Providers also must factor in the cost of handling and storing physical documents and records, at a time when compliance and liability considerations call for more and more data to be archived, stored and managed for long periods of time. Experts now calculate that fully 40% of administrative staff cost is consumed in handling paper-filling, filing and retrieving.

In a 2004 report from the Secretary of Health and Human Services, the U.S. government called for a decade-long push to make healthcare technology more flexible, informative and patient-focused. The mandate includes a coordinated effort by the public and private sectors to achieve a healthcare end state in which "medical information follows the patient."

At the same time, the regulatory requirements of Sarbanes-Oxley and the Health Insurance Portability and Accountability Act (HIPAA) have put significant new documentation requirements on healthcare organizations. HIPAA regulations, in particular, require healthcare organizations to ensure that all operational systems meet stringent guidelines for record capture and retention, security and transaction standards and audit trails.

In addition, the hospital's business office is put at considerable disadvantage by these same disconnected information systems. Much of staff time is taken up in non-value added activities such as locating and retrieving files. This takes time away from activities that increase billing rates, speed payments and reduce time to cash.

Enterprise records management

To meet those challenges, healthcare providers will need a single, consistent records policy focused on the patient and easily accessible to all appropriate personnel at any time in the context of the work that they perform. To be effective, this document and records management system would be built around a single control regime, implemented centrally and applied in a distributed fashion to end-users, without imposing any additional work steps. The stand-alone silos currently used to support and manage hospital departments- from cardiology and radiology to pharmacies, labs and administrative offices-will need to be integrated from a document and records perspective into a single, enterprisewide information system of record.

Precedence

The healthcare industry has a tendency to believe that the issues we face are so unique as to be unlike anything in other industries. This cannot be further from the truth, and many lessons may be learned by studying the use of technology as a problem solver. Let's quickly look at an illustrative example from the banking industry.

Banking and healthcare are the two most heavily regulated industries in North America and share a variety of characteristics. Both are steeped in tradition. Both have adopted new technologies for their customer/patient facing systems. Both have been held captive by their legacy systems, particularly in their business offices. Both keep evidentiary records because of regulation and the litigious nature of both industries. Both have required reporting at the state and federal levels. Both have an ever-increasing volume of paper supporting day-to-day customer/patient interactions and both are experiencing spiraling cost associated with operations.

The difference lies in the additional regulations thrust upon the banking industry, particularly following September 11 and the additional impetus to clean up financial reporting following the recent spate of corporate financial scandals. Banks have had to rapidly adopt new technologies to more effectively manage their records.