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

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