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Is Your Hospital Really Paperless?

Implementing an electronic medical record system is just the start, says EHR expert

It’s tempting to believe that your hospital is paperless once you’ve implemented an electronic medical record (EMR) system or completed an electronic health record (EHR) conversion, says EHR expert Josh Nathan of Freed Associates. While EHRs are the biggest step toward going paperless, most health care organizations still manage volumes of paper that prevent the establishment of an integrated care team –– one in which all information is available to all providers in near real time, according to Nathan.

Health care organizations that are not completely paperless cannot meet Healthcare Information and Management Systems Society (HIMSS) stage 7: a fully digital environment in which all clinical documents are available electronically within 24 hours of creation or receipt. Documents such as outside records, telemetry strips, ancillary results, signed consents, and “shadow charts” that are part of a patient’s overall record often remain on paper and leave health care organizations with paper to manage and a disjointed care environment, Nathan says. The good news is that going paperless can be achieved in a variety of patient care settings and with minimal disruption.

Nathan has worked with several hospitals, both large (400 beds) and small (30 beds), to implement a decentralized point-of-service (POS) scanning model to create paperless systems. The primary advantage of a POS model, he says, is that clinical documentation is in the chart sooner because it is scanned where and when it is created. In addition, it can be staffing-neutral and can allow more resources to be allocated to clinical care than to administrative tasks.

Nathan recommends the following steps to facilitating a POS scanning model:

1. Partner with clinical leadership.

Since the goal of HIMSS Stage 7 is to improve patient care through the sharing and use of patient data, creating a truly paperless stage-7 hospital requires the support of the facility’s clinical leadership team. Clinical leadership needs to determine that scanning is a form of clinical documentation, not an administrative task, Nathan says. It is important that leadership and clinical managers collaborate to ensure full buy-in.

2. Agree on the types of documents to be scanned and who will be responsible.

No more than 10 documents or categories of document should be scanned, Nathan advises most documentation should be entered directly into the HER, and scanning should be the exception. In Nathan’s experience, scanning is done by support staff and almost never by physicians or nurses. In outpatient ancillary departments, the front desk can scan orders and other documents as a step in the registration process, he says. Thereafter, specific staff members may have to assigned to oversee the process.

3. Use technology to make it easy.

One key to obtaining buy-in from clinical leadership is the extent to which the process becomes “intuitive,” easy to use, and fast, according to Nathan. At a recent implementation, he identified which forms each department would scan, defined document types, and created “shortcut” buttons in the scanning interface. As a result, for a document with a patient identifier, such as a bar code or a label, the person doing the scanning only had to select the short-cut button (e.g., “consent”), which identified what they were scanning. That single step sent the document to the correct patient chart and location for fast record retrieval.

4. Partner with the health information management (HIM) department.

The HIM department should own the master list of documents to scan by department, Nathan advises. The list will include documents that must be in the patient’s record, and “miscellaneous” documents that should not be scanned.

“Instead of managing paper charts or scanning post-discharge, HIM can complete quality reviews with easy access to all of the data they need,” he says. “Since HIM still ‘owns’ the chart, they will be reviewing and validating scanned items and making sure they have gone to the right patient and are designated as the right document type. With streamlined and centralized work queues for document review, these tasks can often be completed in less time than it took to manage paper charts.”

Source: Healthcare IT News; April 10, 2015.

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