June 2, 2004
Every day, hospitals face a tremendous irony: using the latest technology to diagnose and care for patients and then using the most archaic modes -- manually filling out, mailing, faxing, copying, and filing millions of paper forms each year -- to get reimbursed. The right document management system can decrease claims denials, decrease accounts receivable, improve patient and employee satisfaction, save storage fees, enhance patient care, and cut the medical records coding backlog. A new HFMA report, sponsored by Hyland Software, Inc., examines the challenges and opportunities of document management systems.
The Changing Nature of Healthcare Business Documents
The challenges organizations face in assessing and auditing internal processes and deciding on the right document management strategies can be immense.
Financing, of course, is perceived as a huge barrier. In addition to coming up with the money to fund the system, appropriate budgeting can slip through the cracks because document management doesn't fall directly in the budget of any particular area within hospital operations. Thus, investments in document management can become unplanned expenses unless the project is addressed by an appropriate team of stakeholders.
Second, until about five years ago, solutions to paperwork burdens tended to be individual, niche-oriented applications that hospitals got from their current information technology providers. Those products weren't usually compatible with existing software nor did they match the work flow of administrative staff and physicians.
Several things are happening now that are making these challenges more manageable. First is the growing multimedia nature of documents. Important information is flowing into hospitals in the form of e-mails, faxes and electronic data. The tangibility of paper necessitated one way of thinking about organization, storage and access, but given the new electronic environment, hospitals are being forced to rethink these approaches. Hospitals are beginning to see that the physical location of documents does not matter as much. This raises new questions of how documents should be identified, where they should be located, and by whom and when they should be accessed.
A New Era in Document Management
The concept of a "document management system" has come a long way since just five years ago when it typically involved only scanning and storing documents -- often using common office equipment such as photocopiers with scanning capabilities.
Today, document management systems offer several ways to capture and store electronic streams of data. Using a document management technology such as computer output to laser disk (COLD), organizations can automatically store, without scanning, print streams from their billing systems such as claims, patient statements, close reports and aging reports. These are stored in the document management systems, alleviating the printing of reams of green-bar reports. Once captured, COLD documents such as claims can be automatically matched to their corresponding documents like an explanation of benefits and charge tickets.
Document management technologies also now have the ability to handle electronic data interchange (EDI) data streams, allowing HIPAA transaction files to be stored and managed in the document management system. Outbound claim files in the HIPAA format and inbound payment and remittance advices can be stored as part of a patient's accounting folder, each transaction becoming its own patient-specific document.
In addition to the capture and storage of documents, an appropriate document management solution can manage the entire life cycle of those documents, including work flow and distribution. Work flow technology provides business process management tools that can reduce the amount of time it normally takes to perform manual exception processes such as managing denials and secondary billing.
Choosing the Right System
The MetroHealth System in Cleveland went through a formal RFP process that took about a year to find the right vendor for their needs and specifications. "We looked at features, functionality and price as the main criteria in selection. Also high on our list was flexibility, so that we could plan for future growth," says Brian Quinn of MetroHealth.
When considering vendors for a document management system, keep these points in mind:
Decide that you want to invest in a system only once. Ask vendors how they can help you achieve the goal of not having to purchase technology again and again.
Think of integration as a key issue. The document management system you choose needs to integrate seamlessly with the core software your facility uses daily. That way, employees can work in an environment they're comfortable with.
Evaluate scalability. Look for a system that is more than just scan-and-store, but one that has the ability to grow with you as your needs grow. Ask if the system can be easily used in multiple departments, including operational departments such as human resources, accounts payable or facilities management.
Look for web-based storage and management. Web-based solutions provide a single point of access for all healthcare documents and, thus, improve document accuracy by minimizing the opportunity for human error. It also provides an effective method for distributing documents. Additionally, web-based storage and management offer on-demand printing and forms management, which allow for timely form revision as requirements change and help standardize data output and presentation.
Inquire about support and maintenance. Ask a vendor how upgrades are handled. What happens for you as a client in terms of financing and compatibility when there are new versions of the document management system?
Future Plans
Document management systems that affect the revenue cycle can be the first step toward a wider rollout of electronic capabilities. Directly introducing a document management solution in one area of a hospital often leads to a desire to apply that technology in other areas (such as medical records and the back office). This transition happens most smoothly when a hospital chooses to initially invest in an infrastructure that will allow for upgrading and expanding. Careful planning here will help you avoid the need to support disparate document management systems in each functional area of the organization.
SOURCE:
Stop the Paper Chase! Document Management for Today's Hospitals, a collaborative effort by HFMA and Hyland Software, Inc. HFMA members received a copy of this report with their June issue of hfm.
Additional Resources
- Find document management vendors in the hfm Resource Guide.
- "One CFO's Success with Transitioning to an Automated Patient Record," February 2003 hfm (on-line access available to HFMA members only; non-members please see additional retrieval options).
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble.
HFMA Wants You to Know ISSN: 1540-0697. Volume III, Issue 12. Copyright 2004, Healthcare Financial Management Association. All rights reserved.