Friday, May 14, 2010

Document Management in Healthcare

What is Document Management?

For a variety of definitions from the Web, click here.

I like examples to illustrate definitions so here's mine from heatlhcare.

Most doctor's offices have a room in which they store patient folders, often referred to as charts.  In these folders are stored the paper that describes the care provided to the patient and typically includes

  • physician notes that detail how the patient presented, what was discussed, symptoms that the physician assessed, the diagnosis the physician arrived at, and the treatment / prescriptions ordered to address the symptoms
  • medical laboratory results from tests perfomed due to physician orders
  • prescriptions ordered
  • medical histories, often completed jointly by the patient and a nurse or the physician
  • and similar content.

Usually these folders have tabs that segregate the documents and nearly always the documents are organized so that the most recent document is at the top - this is an illustration of the Last In / First Out principle.

From a volume perspective, in the US, there are approximately 400 patients / doctor overall.  But for primary care physicans, the patients / doctor ratio is in the thousands and likely close to 4,000 patients per doctor.  So, a brand new, single-physican practice after a year will likely have 4,000 charts.  Established single-physican practices have ~10,000 charts and  established multi-physican practices can reach 100,000 charts fairly quickly.

Put another way, doctor's offices have thousands of paper folders stuffed with paper.

If your labor costs are low, then relying on people to manage folders is a good use of money.  On the other hand, as your labor costs rise, the value of automation increases. 

One simple automation is to convert the paper stored in the folders to images and make those images availble to physicians.  We do this by using a piece of hardware known as a scanner - a scanner takes paper and creates electronic pictures of the pages.  Staff then identifies each picture (this is known as indexing) and the picture is added to a software application known as a Document Management system.  In turn, the physician can type the patient's name and all of the scanned documents are listed for the physician to view.  The physician selects a document to view, and it is displayed.

Abstracting this illustration leads one to other paper-intensive markets such as insurance, financial services, government, engineering, and so on.  Abstracting this illustration also leads one to other content-intestive applications, such as law firms, web sites, marketing ,  and so on

While each of the above have unique requirements for which vendors have created specialist applications, they all fall into the broad category of Document Management applications.

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