The flow of IT in Healthcare

This diagram shows the information flow for a patient in the healthcare information realm. As you can see, the flow goes as fast as it can toward billing insurance. It does not necessarily care about the patient and the quality of the information. As long as there is an account number, it’s full steam ahead!

As a patient, you feel this. What’s the first thing you do when you go to the doctor’s? You don’t get triaged, you get asked for billing information and oh, by the way, what are you here for? Shouldn’t it be the other way around, like when you bring your car in for service? Have it checked out, then if there is an issue, talk about how much it’s going to cost, then agree or disagree to the service.

Information Technology is a patch applied to a system wrought with politics and policies which have been analyzed over and over again by the best consultants money can buy. It’s a wonder that IT has been this successful in pushing its automation techniques into the heart of healthcare. The disputes between nurses and doctors continue, IT is in the mix now. As Healthcare systems own insurance company, so do insurance companies own hospitals and physicians. Everyone is in line to make money to survive and grow.

Expanding healthcare is fine, but the issue is that the patient has to be vigilant more than ever to ask for all visit related and referred information. They will be tangled in the vines if they are not the keeper of their electronic records.

OnBase VB Script and Thick Client API to export all image pages

Link to other onbase scripts.

Below is an OnBase VB Script and Thick Client API to export all of an image's pages:

Sub Main35()

Dim objApplication, objCurrentDocument
Dim MZ_API, MZ_FIRST
MZ_FIRST = 0
Set objApplication = CreateObject("OnBase.Application")
Set objCurrDoc = objApplication.CurrentDocument
Dim filePath, memHandle, MZ_LOCALPATH, MZ_MULT_TIF4
memHandle = 0

Dim exportDirectory
exportDirectory = "\\share location\"

Dim mzApiSessionHandle, mzAPI
mzApiSessionHandle = ScriptAPI.Session
Set mzAPI = ScriptAPI.Object
Dim returnCode : returnCode = 0

'MsgBox "objCurrDoc.Handle is-" & objCurrDoc.Handle

returnCode = mzAPI.mzInitQueryByDocumentID(mzApiSessionHandle, objCurrDoc.Handle)
'MsgBox "1 returnCode is-" & returnCode


Dim mzApiQueryHandle
mzApiQueryHandle = returnCode
returnCode = mzAPI.mzExecuteQuery(mzApiQueryHandle, 0)
'MsgBox "2 returnCode is-" & returnCode

Dim returnDocumentHandle, outDocumentName, outDocumentType, outDocumentDate, outFileFormat, outRevision, outComment, msg

returnCode = mzAPI.mzGetDocumentInfo(mzApiQueryHandle, MZ_FIRST, outDocumentName, outDocumentType, outDocumentDate)
returnDocumentHandle = returnCode

Dim fileExtension, returnedFilePath
fileExtension = "TIF"

returnCode = mzAPI.mzGetDocumentPage(mzApiQueryHandle, returnDocumentHandle, -1, "Image File Format", 0, 1, 8, returnedFilePath, memHandle)
'MsgBox "returnCode: " & returnCode & vbcrlf & "returnedFilePath: " & returnedFilePath
returnCode = mzAPI.mzEndQuery(mzApiQueryHandle)
Set mzAPI = Nothing

Set fso = CreateObject("Scripting.FileSystemObject")
fso.MoveFile returnedFilePath, exportDirectory & objCurrDoc.Handle & ".TIF"
Set fso = Nothing

End Sub

Healthcare IT: Medical Record or Getting Paid?

So what takes information priority at a hospital, integrity of the medical record, or accuracy of a patient encounter for billing insurance? One keeps the customer coming back, the other keeps the money flowing. It's interesting that many information quality issues are push backs from insurance: the coding is incorrect, the patient's name is wrong, there is no signature, the medical record number is one digit off.

A false assumption is made that hospitals of the future are all online and fully automated. This assumption pervades the big data quants. Big data indexing is not as easy as plugging into an EMR and indexing everything in a cloud. First of all, even with a link from the search hits to the original EMR source, all of the data is not present, it may reside in an ECM system used for scanning and workflow. It may still be 20% on paper. OCR fails at 99% accuracy, Big Data fails at 99.99% accuracy. It has to be flawless to work, that's the issue.

Back to the quality issue: the information motivation is split between data integrity within tables and integration, and with applications, many of which serve the requirements of ICD-9 not the patient's continuity of care. The way access services creates a medical record number and metadata is fine. The problem is that with multiple visits new records are added, some are incorrect. If the procedure is correct and that account number is correct, send it to revenue, let's get paid. Hospitals have deadlines for submitting bills. This forces them to be constantly one step behind the curve for automating their processes and cleaning up their data. They don't have the time.

ECM pushes quality up the stack

ECM, being a sea bottom dweller, has many opportunities to detect and fix issues with information architecture. This depends on the breadth of implementation and integration of the system, however, in most cases, applications which rely on metadata accuracy for processing and presentation will route out issue.

Many times an implementation will bump into a information quality issue by chance, for example, in a healthcare setting, billing information is used as the basis of coding patient tests. The source of this information comes from a registration system and if the hospital is large enough, it comes from multiple registration systems. The patient account number needs to be correct for insurance billing. For auditing purposes, the downstream/bottom dweller ECM system needs to be accurate. If it is not, then the exception is sent back up the stack for fixing. This fix more often than not exposes glitches/bugs in the way the integration engine functions. Sometimes it exposes issues from years ago, but a patient's chart information could have many years of visits and discharges associated with it, as well as non hospital related tests add to it. The bottom line is that an ECM system may only be used for scanning and indexing images, but it most likely is driving quality up to the surface of the more mission critical applications.

Recommendations vs. Requirements

I read an email from an IT director a few weeks ago that was explaining how we should proceed with a particularly troublesome issue. The email explained that the User's of the system can "recommend" changes to the website, and that IT will "review" them. It's old school to say "recommend", like really old school, before the concept of documenting requirements to solve a business problem old school.

How does this happen? How can IT management still think that they have the innate ability to understand the intricacies of what business User's want without documenting requirements? It can't and that's the point.

With most information technology, the people who know how the software is designed to solve issues are the first ones to evangelize the usefulness of it. They are usually very familiar with the business processes and at the time know a lot about what the Users need. However, over time these same folks will inevitably lose that edge. That is when they need to start asking their User's what they need. The problem is that pride and prejudice enter into the behaviors and thoughts of the original designers of the system. They are the architects. They feel entitled to dictate what should and should not be included in future designs.

Thus, please be sure there is ample documentation of requirements and functional specifications which solve the issues, and that these docs are updated or superseded. The worse thing that can happen to a system in the long run is to rely on one architect for all design questions and answers because the one person is surrounded by many who have unique perspectives and could potential have more innovated ideas on how to solve problems.

Healthcare ECM is a safety net

Let's face it, the implementation of ECM systems in healthcare is done as a cheap safety net. What I mean by this is that a Director or VP looked at their EMR for example and realized 20% of the results and clinical notes were still in paper form. The price of a scanning solution offered from the EMR software company was prohibitive. In comes a less expensive player, like Hyland OnBase, and fill the gap, creates the safety net.

Smart software companies like Hyland know that their base product is the low bidder, however they have modules that add up in price as more functionality is required. The key is to have the best niche product along with the ECM software. In Hyland's case it's their scanning solution.

ECM as the safety net is not a bad position to be in. Being a "blank slate" so to speak starting out, this allows motivated individuals to build point solutions internally, which, assuming that the company has a good methodology in terms of solution development, can help solve many issues. The expensive alternatives may never even get considered if the financial benefits are not good enough given the cost.

ECM development is flexible, it is up to the IT group to solution architect to the level of competing point solutions. We know that projects of today will be usurp as off the shelf products of tomorrow. This is a one of the ways the ECM pushes innovation in the industry. A trend in a solution across an industry is bound to result in a software product that kills the ECM solution of a 5 years ago.

Fax to directory to ECM capture disk sweep

If you have a multi functional device, you might have the capability of saving incoming faxes to an attached PC or storage device. The fax can usually be saved as a PDF or TIF. The folder where you save the fax image is based on your ECM's scanning configuration. This configuration is scheduled to "sweep" the folder location periodically to import the images. The processing of these images is preset, meaning that the images might have barcodes to be read for indexes, or be routed to a workflow. This type of processing is common in companies that have MFDs that are dispersed. It can save on licensing fees and scales.

Back to pathways.