Fragmented Document Practices Add Cost, Heighten Risks and Hamper Clinical Performance

This article, the first in a series of four, is designed to provide you with an overview of the issues and costs associated with enterprise document management.  Subsequent articles will focus on specific print environments and opportunities for improvement.

Documents are at the heart of every business process, and for healthcare providers, those documents assume increased importance because of the integral role they play in clinical and administrative functions.  Face sheets, charting documents, admitting forms, lab, radiology, and pharmacy orders and documentation– they’re all essential to patient care – as are the plethora of documents that support training, marketing, accounts payable and other business functions that make a healthcare system run. 

Not surprisingly, document management is expensive and time-consuming.  Industry analyst InfoTrends estimates that the average healthcare organization spends $3 million annually on forms and all types of printed materials. And those are just the direct printing costs. 

Fragmented Structure, Disparate Activities
Most healthcare providers lack a complete understanding of their total investment in creating, printing and managing documents.  They tend to view document management in a highly fragmented way, often only within a clinic or department, rather than looking at the process across the entire enterprise.

For large healthcare organizations, printing typically occurs in several distinct environments, each with its own discrete management and reporting structure. For example, desktop printing is generally under the auspices of the computer network group, while copiers and faxes have traditionally been the responsibility of procurement departments.  Centralized reprographics, more commonly known as the print shop or copy center, may be a part of mail or administrative services, whereas data center printing remains staunchly part of the information technology organization.  The marketing department most often contracts with outside providers of offset printing, while various individuals and work groups procure their ad hoc print jobs from local copy shops. 

Hospitals also rely heavily on pre-printed documents for patient charting. The procurement department often manages these documents, but often it is the unit clerk who is responsible for ordering the forms and ensuring there is an adequate supply on hand.

With this disconnected document activity, most hospital systems do not have a clear view of their total document-related expenses and they can’t be sure whether associates’ printing habits are in the best interest of the organization as a whole. Little, if any, attention is paid to how, where and why users engage printing resources. More cost-effective and efficient methods may exist, but they are overlooked due to lack of information, force of habit or the urgency of replenishing forms.   In fact, the common sentiment is, “I don’t care how the form is printed; it just better be there when I reach for it.”

Accurate Documents – STAT!
Indeed, when forms contain a patient’s unique information, the availability and accuracy of the document, itself, becomes even more critical.  How it is stored and delivered – whether printed on paper or pulled up on a PC – the technology used is secondary to the document’s accuracy and availability.  To ensure this reliability, hospitals must address the entire document-related life cycle and all associated supply chains, not just the output.  When healthcare systems gain a comprehensive understanding of how documents are created, revised, used and delivered, they are better positioned to improve the reliability, efficiency and accuracy of the critical documents that drive clinical procedure and workflow.  At the same time, they get a better view of the savings opportunities that exist enterprise-wide.

Addressing Compliance Requirements
Industry standards and regulatory requirements add to the complexity of managing documents.   Faced with Health Insurance Portability and Accountability Act (HIPAA) requirements and continually changing standards from the Joint Commission of Accreditation of Healthcare Organizations (JCAHO), administrators are challenged to ensure staff members have the most current version of consent forms, patient assessment forms, standing physician orders, medication records and other vital documents.  

Consider, also, the need for using the correct, up-to-date International Classification of Disease (ICD) codes.  These codes are essential to capturing accurate treatment charges.  Incorrect coding leads to billing chaos which can seriously impact productivity and delay collections. 

No one would argue that maintaining proper version control is essential. Nonetheless, the task is overwhelming for many hospital systems, particularly where forms are not standardized.  It’s not uncommon for one system to have 6,000 or more documents in use. By standardizing document characteristics across the entire organization, updates can be implemented once for all the related documents.  Revisions can be facilitated more easily and quickly, and costs can be reduced.  In fact, hospitals that have examined their revision process found that lack of standardization had driven up their procurement costs by as much as 15% to 30%. 

Moving to EMR
Standardizing documents and document design also improves scanning and data capture operations.  How efficiently and accurately documents can be scanned and indexed into an Electronic Medical Records (EMR) system like those offered by McKesson, Cerner or MEDITECH, is dependent upon specific attributes that are improved with standardization.  For instance, standardizing the location of a patient’s name, insurance information or bar-coded patient ID can dramatically improve the throughput of scanning operations.  Likewise, by integrating intelligent bar codes and other methods to automatically extract metadata can increase the accuracy and availability of critical information across the entire EMR system.

The Total Cost of Ownership
Research indicates that over 30 billion documents are used each year in the US.  The cost of producing and managing those documents is estimated to reach as much of 15 percent of corporate revenue.  

Healthcare industry  analysts estimate that for every dollar spend on purchasing paper forms, up to $9 is spend on processing those forms.  This figure climbs higher when considering other burdened costs including support and infrastructure, procurement and facilities, end-user interaction time and document management expense. These costs are hidden in budgets and processes through the entire enterprise. 

Understanding an organization’s overall enterprise document expense is a challenge.  However, without this information, it is impossible to assess the magnitude of the savings opportunity and to develop a meaningful document management strategy.

Positioning for the Future
Governmental mandates, such as HIPAA, are pushing hospitals into the electronic age.  Mandates regarding EMR and electronic data transfer will impact the way hospitals must do business.  By stepping back and building a more holistic view of document management throughout their enterprises now, hospitals and other healthcare organizations can significantly cut costs, improve patient care and position themselves for the future.

Next Insight: Desktop Printing
The next issue of Insight will give you a closer look at desktop printing – costs, trends and best practices for reducing expenses in this environment.  However, if you want immediate information about gaining a comprehensive view of your enterprise , contact us now.