Thursday, February 28, 2013

Scanning Forms can be Tricky

When scanning into batches and selecting document types to index, there are many issues that cause misfiling. Below is a list of findings from a typical set of scan queues across different departments and facilities:

·         Forms with Exact Name as Doc Type are more accurately filed.

o   Exception: Admission Orders: Bariatric Surgery Procedures                   

·         It helps to have a standard form across practices and checkbox to distinguish the location

·         Forms with labels are more consistently filed

·         General doc type names get all of the misfit forms

·         Some misfiles are from changes to doc types which leave the old docs in general types and the new ones go to the newer more specific types

·         Inconsistent form headers and footers cause misfiles

·         Machine printed forms are more accurately filed

·         Some Doc Types have less than 10 scans in them

·         Very specific names gather all forms of that name whether they are correct or not, for example: “pH” or “Esophageal”

·         Barcoding for doc types is very accurate, however, the form names need to be consistent and sometimes the barcode doc type is manually re-indexed to a different doc type

·         General Form Names as a Heading (large type) with specific names as sub heads underneath sometimes get misfiled

·         Some Doc Types were created for a specific facility and are misfiled against because they don’t have the same form names as other facilities, ex. HIV Informed Consent

·         Regardless of language, the forms should have the same template layout

·         Forms should be consistently scanned, for example, the same front page, number of pages, layout, etc.

·         Redundant doc types should be consolidated: “Consent for Participation in Pet Visitation Program” and “Consent for Participation in Animal-Assisted Therapy Program”

·         Non-company forms are mixed in with company forms

·         Some redundant doc types are used by different scan queues, for example one facility uses both “Peripherally Inserted Central Catheter (PICC) Consent Form” and “Peripherally Inserted Catheters Consent”, while the other facility uses “Peripherally Inserted Catheters Consent”

·         There are clusters of doc types that are close to the same definition that should be considered for consolidation, for example,

o   HIV Informed Consent

o   HIV Testing Consent Form

o   HIV Testing Informed Consent, Health Care Worker Exposure

·         Doc Types no longer in use should be taken out of the scan queues

·         Some doc types have names that are too limiting: ex: “Sterilization Consent Form Ages 21 or Older”, where some of the forms are for ages 18-21…

·         Some doc types have “or” instead of “and”: ex:  doc type is  “Consent for Surgical or Diagnostic Procedure”, while the form’s name is “Consent for Surgical and Diagnostic Procedure”. The “or” suggests that this could be for either surgical or diagnostic procedures, not both…

·         Groupings of types should start with the same label value

·                         Example: consents should all start with “Consent”, then the second defining label

·         General types should be further detailed

·         Specific department types overlap general types

Sunday, February 24, 2013

The road to no paper in healthcare

Of course the end goal of any paper in your organization is full conversion of paper to online forms, however, scanning paper is an intermediate step toward this goal.

According to Seth Godin, this should not be a “finite game” where there are winners and losers, this should be an “infinite game” where we implement a strategy to become more connected and raise all Users’ ability to serve.

Outline of Steps and Considerations

IT Strategy Component

At the highest levels in IT, there should be a healthy understanding of the positive effect of rules for publishing and presenting information. What I mean by this is that the information on paper is priceless and yet the techniques of gathering, collating and aggregating are from twenty years ago. Even with paper, rules need to be created and disseminated on form templates, fixed information boxes, choices instead of free text, etc. These will have to be decided at some point, why not get it started now...

IT stability

There will need to be a fallback Plan for unexpected outages and routine maintenance downtimes for when the system changes and evolves. This will most likely be paper forms or local backups on the network which could get synced up later.                        

Information Integrity

Need to clean up the metadata of the paper and scan types: naming conventions of form types, folders, metadata: look for implicit hierarchy in names

To Barcode or Not

If you don’t have advance capture to train on fixed forms which are controlled within the organization, then you should use barcoding to reduce indexing times and inaccuracies. That said, you might want a bar code available to add to forms when printing for patient information requests or transfers so that the form type can be read from other sources.

Centralize vs. Distributed (hospital content)

  • Pro: Easier standardization, less configuration, thus easier change management
  • Con: Less location specific knowledge

  • Pro: Easier transition to electronic forms?
  • Con:
    • Registration
    •  First system which Patient information is entered
    • Forms and Signatures
      • eSignature possibilities
      • eForms and HL7 messages

Form Origin: within or outside of company

Docs within control

  •  Information quality assurance
  • Form standardization (across locations)
  • Predictable Format
  • Scan/Index standard forms
    • General OCR
    • Zonal OCR
    • Template recognition
  • Systems of origin
    • Registration
    • EMR
    • Billing
  • Building eForms from standard forms
  • Form Differentiation
    • identify and categorize the forms by functional groups to have scope and front load the system with abilities to convert to eForms in the future
    • Patient Forms
      • Signature required
      • Patient and Witness signature required
      • Other information added and signature required
      • Other information added
    • Types of information required?
      • Clinical Forms
        • Medical signature required
        • Medical signature required and Patient signature required
        • Other information and Medical signature required
        • Other information and Medical signature required and Patient signature required
        • Other information added
      • Other Forms
Doc outside of control

  • Unpredictable format
    • Collect paper samples by categorization from groups responsible for scanning them
    • Determine patterns of categories across all document types and sources
    • Ask for style guidelines from outside sources
  • Predictable Format
    • Standard Form Scanning
    • Standard barcodes
    • Standard information interoperability

Saturday, February 9, 2013

Cost "Profiling" IT

Seth Godin, in "The Icarus Deception", wants us to learn how to see, to make, and to begin from a blank slate. We are all artists, he says, and "You need to know the conventional wisdom inside and out. Not to obey the rules, but to break them".

We tend to "profile" projects and copy what has worked in the past, or see projects based on models. IT operations does not like change, or breaking the model, they want to quantify and execute their projects. For example, this enterprise software will help consolidate all rogue applications having to do with X. The Users of X will have to conform to the standard enterprise software in order to save money.

So, the convention is to save money on an enterprise application through consolidation and scale, but to customize it because the out-of-box functionality is too generic to satisfied the needs of every group. Each customized feature, makes the application harder to change. The application could grow to be too big to upgrade within the downtime window.

The Users and applications are "profiled" and the solution is crammed down the enterprise. Is there a five year technical plan with the five year operations plan? I doubt it. Does cost profiling really suit the Users in the long run? What would happen if business groups could pick and choose their applications like we do from a cell phone menu of apps? The menu would be the enterprise; the app choice would be the business's. We need to really embrace self service at the enterprise level. Self service with simple to configure apps, what a concept...