tag:blogger.com,1999:blog-88797540275894958382024-03-13T10:23:13.016-07:00ECM in HealthcareSharing observations about enterprise content management in healthcare.Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-8879754027589495838.post-44166578597205484442011-09-09T13:18:00.000-07:002011-09-09T13:18:30.078-07:00What to do when the storm hits<div dir="ltr" style="text-align: left;" trbidi="on">
I live to the south and west of Boston and have some "lessons learned" to share as a consequence of our recent experiences with Irene.<br />
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<br />
<ol style="text-align: left;">
<li>When you decide that the storm is going to cause a loss of power, go buy ice as soon as you can! And then buy some more for your neighbors and friends.</li>
<li>It's really nice to have a battery operated radio and candles.</li>
<li>Plan to use your barbeque to cook up your thawing foods - and you can boil water on it too!</li>
<li>Cold showers get old. Because we have an oil-fired furnace that also heats our water, I learned how to hook the furnace up to an external generator. It's really not too bad.</li>
<li>If you want to use your cellphone and other devices after the power goes out, make sure you've charged them! </li>
</ol>
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Pretty short list.</div>
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Good luck!</div>
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Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-43105471875445896942011-05-20T13:49:00.001-07:002011-05-20T13:49:16.693-07:00Social Media in Healthcare - Observations from HIMSS Detroit<div dir="ltr" style="text-align: left;" trbidi="on">This week I attended the <a href="http://www.mi-himss.org/">HIMSS Michigan Chapter</a> conference, <a href="http://ihcs.msu.edu/HIT/wiring2011.php">Wiring Michigan for Health Information Exchange</a>. This was a more intimate affair, by far, than the annual HIMSS Conference, but no less productive - and in some ways more so as it was much easier to chat with vendors and colleagues during the breaks.<br />
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<div class="MsoNormal">Among other breakouts, I attended the “<i>Social Media, Healthcare and the Law</i>” presentation conducted by attorneys from <a href="http://www.dickinson-wright.com/Information-Technology--Security-Law-Services">Dickinson Wright</a> (Brian Balow, chair of their IT Law Group and Tatiana Melnik, an associate). </div><div class="MsoNormal">One observation they made was: Use email to document your decisions – not for internal deliberations! The reason is that email is discoverable. Using email for decision deliberations commits to “paper” topics and ideas that may not have had a significant bearing upon the final decisions – but can be used in court to paint a picture that doesn’t reflect what took place. So, don’t use email to conduct your deliberations.</div><div class="MsoNormal">They also provided a nice justification for “Why to have a Social Media Policy:”</div><div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"></div><ul style="text-align: left;"><li><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span>To provide a structured framework within which employees can use social media safely</li>
<li><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span>To protect patients’ rights</li>
<li><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span>To instill professionalism</li>
<li><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span>To protect employees and the organization from liability</li>
</ul><br />
<div class="MsoNormal">The core issue with healthcare professionals using social media tools is that of patient privacy. We are obligated to keep protected health information secure and to specifically prevent disclosure. </div><div class="MsoNormal">Furthermore, the HITECH act requires that healthcare organizations (known as covered entities), business associates, and subcontractors address breaches: investigate, give notice to the affected patient(s), reprimand staff, and notify the Secretary of HHS. I found two points surprising: first that the HITECH act does NOT preempt state law (so you can face legal action under both Federal and State laws) and second, that State Attorneys General have the “…power to enforce HITECH breach provisions” And some have, resulting in significant settlements.</div><div class="MsoNormal">Their recommendations for creating a social media policy include:</div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"></div><ul style="text-align: left;"><li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Be transparent and authentic</li>
<li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Be responsible for what you write</li>
<li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Protect PHI as well as proprietary information</li>
<li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Use common sense and common courtesy</li>
<li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Think twice before you post!</li>
</ul><br />
<div class="MsoNormal">Additionally, there was a February 24, 2011 <a href="http://www.hhs.gov/ocr/privacy/hipaa/news/index.html">settlement </a>in which Mass General agreed to pay a $1M fine as well as implement a monitored, multi-year corrective action plan. While this particular breach did not involve social media, it does illustrate the costs of breaches.</div></div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-63855123428835372972011-03-29T12:26:00.000-07:002011-03-29T12:28:53.187-07:00Observations from HIMSS 2011 - First Up "Social Media"<h1><span class="Apple-style-span" style="font-size: small; font-weight: normal;">I attended the annual HIMSS show, which was held in Orlando this year. I'll post some of my observations from the show. First up, Social Media!</span></h1><h1>Mayo Clinic Center for Social Media</h1><div class="MsoNormal"> I attended a Mayo session in which the Lee Aase discussed how Mayo has executed their social media strategy. Here’s a link to his <a href="http://www.slideshare.net/LeeAase/himms-views-from-the-top-presentation">presentation</a>. Lee is the director of the <a href="http://socialmedia.mayoclinic.org/">Mayo Clinic Center for Social Media</a>. </div><h3>10-20-30 Rule for Presentations</h3><div class="MsoNormal">Guy Kawasaki, who was previously a leader of Apple, recommends the 10 20 30 rule: the 10 represents no more than 10 slides, that 20 represents no more than 20 minutes and the 30 represents no text at less than 30 points shall be presented. Good recommendations to live by!</div><h3>Use Flip Video – Not Blogs</h3><div class="MsoNormal">Lee also recommended that healthcare should not start in social media with a blog, because blogging is a written skill and requires hard work. Instead, use what you already have and then use that content across many channels. </div><h3>Why Video?</h3><div class="MsoNormal">Lee recommended the use of voice and video; specifically conducting 20 minute or so interviews. He was a big advocate of the use of the Flip phone for capturing both voice and video when conducting an interview of your personality. Not only is the video produced by the Flip device acceptable, it's tremendously less expensive than professionally produced video. Additionally, the video that's created tends to have greater value in the eyes of the viewer because it’s <i>not </i>professionally developed. Lee detailed the following as key reasons for voice / video:</div><div class="MsoNormal"><br />
</div><div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo2; text-indent: -.25in;"></div><ul><li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Nimble alternative to news releases</li>
<li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>TV producers can “try before you buy”</li>
<li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Sound & motion instead of word pictures</li>
<li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Lowers the threshold for “news”</li>
</ul><br />
<h3>Why Social?</h3><div class="MsoNormal">Lee also pointed us to his “<a href="http://social-media-university-global.org/35-social-media-theses/">35 Social Media Theses</a>,” two of which I found particularly compelling:</div><div class="MsoQuote" style="margin-left: .5in;">“Paying for advertising while not taking advantage of free online opportunities isn’t particularly astute.”</div><div class="MsoQuote" style="margin-left: .5in;">“You can save enough using free social tools in your current work to pay for your expanded efforts in social media.”<w:sdt citation="t" id="81095876"><span style="font-style: normal;"> (Aase, 2011)</span><span style="font-style: normal;"></span></w:sdt><span style="font-style: normal;"><o:p></o:p></span></div><h3>Unholy Trinity: Legal, IT, & PR</h3><div class="MsoNormal">Lee also had a humorous reference to those that prevent the use of social media tools within an organization and he referred to them as the “Unholy Trinity:” Legal, IT, and PR. When he was asked about how to address legal concerns, he had several recommendations:</div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"></div><ul><li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Provide a standard disclaimer: the purpose of the disclaimer is to point out that the material presented is general in nature and tailored to a condition or disease, but specifically is not addressing an individual patient's situation.</li>
<li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Provide lots of content: the purpose of lots of content is to develop credibility and drown out mistakes. In other words, if you have lots of content, and one particular video has a mistaken it, the mistake is more easily accepted by the public when it is surrounded by a sea of positive content. If you make a point of acknowledging your mistakes quickly and those mistakes are drowned out by all of the positive content, then the mistakes become much less dangerous. Perhaps a different way of looking at it is this: If the only content you have presented through social media are mistakes then you’ve got as a crisis; on the other hand, if you have lots of content, and one mistake, then it's really not a serious problem.</li>
<li><span style="font-family: Symbol;">·<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span>Faux Paux Fridays: the purpose of the “Faux Paux Fridays” e-mail is to continue educating those that produce content about mistakes that people make. As an example in a recent Faux Paux Fridays e-mail he sent out a story about a surgical nurse who had taken pictures during surgery and posted them to her Facebook account. That was obviously a mistake and it was an easy way to reinforce the fundamental restrictions protecting health information, PHI and HIPAA.</li>
</ul>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-20648014201431203452011-01-11T07:43:00.000-08:002011-01-11T08:13:29.934-08:00Telehealth?<div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Last night I attended an MIT Enterprise Forum event titled, “What Does Telehealth Say about Technology Adoption?”<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Here’s a picture of the panel: </span><a href="http://www.meetup.com/MITRFID/photos/1216543/20744648/#20744558">http://www.meetup.com/MITRFID/photos/1216543/20744648/#20744558</a></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">The panelists were:<o:p></o:p></span></div><div class="MsoListParagraph" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"></div><ol><li><span style="font-family: Arial, sans-serif;">Dr. Adam Darkins (Veterans Health Administration) – he was a neurosurgeon then switched to IT in healthcare. He’s led the implementation of nation’s largest home-based health monitoring system which has improved care for 46000 chronic-condition patients. They plan to get to 92000 patients next year.</span></li>
<li><span style="font-family: Arial, sans-serif;">Naomi Fried, PhD (<a href="http://vectorblog.org/gathering-the-innovators-at-childrens-hospital-boston/">Children's Hospital Boston</a>) – she worked at Kaiser focusing on innovation and has recently joined Children’s to accelerate their market expansion into telehealth with the key goal of expanding their market share in tasks unique to pediatrics.</span></li>
<li><span style="font-family: Arial, sans-serif;">Bruce Lehman (<a href="http://lehmanmillet.com/about.php">LehmanMillet</a>) – totally focused on healthcare marketing.</span></li>
<li><span style="font-family: Arial, sans-serif;">Dr. Steven Locke, (Harvard Medical School, president <a href="http://veritashealthsolutions.com/about-veritas.php">Veritas Health Solutions</a>) – he’s a practicing psychiatrist bringing to market remote depression treatment.</span></li>
<li><span style="font-family: Symbol;"><span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span style="font-family: Arial, sans-serif;">Edwin Simcox, Jr. (AT&T <a href="http://www.att.com/gen/press-room?pid=18708">ForHealth</a>) – he joined ATT to help in the formation of the ForHealth division.</span></li>
</ol><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Some of my observations:<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;"><b>Telehealth / remote heatlh / eHealth / etc will take off when a reimbursement technique is accepted</b>. While these solutions often reduce costs and improve quality (particularly consistency in delivery), they have not been adopted on a widespread basis because payment processes are not globally in place. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Marketing and selling into healthcare is a long road – healthcare buyers are the most conservative in the market because they have been trained to work within well-defined “guardrails” (first, do no harm) and they perceive that they are “all knowing”. On the other hand, once you’ve secured a presence in healthcare, you can grow that position in a well defined manner. Bruce Lehman offered up a new “4P’s” (the classic marketing 4Ps are Product, Price, Placement, Promotion): <o:p></o:p></span></div><div class="MsoListParagraph" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"></div><ol><li><span style="font-family: Arial, sans-serif;">Protect – Limit exposure to widen opportunity - once you get your product into healthcare, protect it, protect it, protect it!</span></li>
<li><span style="font-family: Arial, sans-serif;">Promise – Sharpen your vision through the eyes of your users - define the specific capabilities and outcomes delivered by the solution</span></li>
<li><span style="font-family: Arial, sans-serif;">Proselytize – Find followers who will lead - you’ve got to get the word out in a healthcare-acceptable manner</span></li>
<li><span style="font-family: Arial, sans-serif;">Propel – Focus and fire (When the time is right, GO BIG, or go home….)</span><span class="Apple-style-span" style="font-family: Arial, sans-serif;"> </span></li>
</ol><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Dr. Locke shared that the “motivational interview” technique is proven to be as effective as medication for depression – but medical students don’t learn the technique in large part because they know that the market situation they’re moving into is bound by the “7 minute” patient/doctor window. And they don’t get reimbursed effectively. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Because the developing world doesn’t have our brick ‘n mortar investments (if you take the patients out of the hospital, you still need to cover the costs of the beds), developing countries are more likely to adopt telehealth techniques.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Telehealth holds the promise of shifting the healthcare delivery paradigm from today’s doctor-centric to patient-centric. This refers to the non-acute care scenario (when you schedule an appointment to visit the doctor, travel there, wait, wait some more, get seen for 7 minutes or less etc).</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial, sans-serif;">Another way of segmenting the healthcare market is into the patient’s health status: Well, At-Risk, Chronic, and Acute. This approach can make it easier to market products in a more appropriate manner. The offerings of <a href="http://www.americanwell.com/aboutus.html">American Well</a> are an illustration of this market segmentation.<o:p></o:p></span></div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-33187388384571136932010-11-29T08:18:00.000-08:002010-11-29T08:18:13.170-08:00"The Direct Project " aka how to connect!<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;">A vexing problem looks to be on a path to being solved! </span><br />
<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;"><br />
</span><br />
<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;">The vexing problem? How to take the paper out of the communications process!</span><br />
<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;"><br />
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<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;"><br />
</span><br />
<span class="Apple-style-span" style="color: #333333; font-family: Arial, sans-serif; font-size: 20.16px; line-height: 18px;"><a href="http://wiki.directproject.org/">"The Direct Project"</a> is </span><span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;">developing specifications for a secure, scalable, standards-based way to enable participants to send encrypted health information directly to known, trusted recipients over the Internet. In my view, this is the direction necessary to eliminate paper as the communications protocol among healthcare participants - namely providers!</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;">For example, a primary care provided needs to refer a patient to a specialist or to a hospital. Today, these tasks are accomplished primarily through paper, often with fax. The Direct Project will enable a purely electronic solution! Here are other "<a href="http://wiki.directproject.org/User+Stories">stories</a>" that have been defined.</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;">And, here are some initial test implementations:</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, sans-serif; font-size: 18.72px;"><span class="Apple-style-span" style="font-family: arial, helvetica, sans-serif; font-size: 18.72px; line-height: 19px;"><a class="wiki_link" href="http://wiki.directproject.org/Pilot+Project+Brief+-+Rhode+Island+Quality+Institute">Pilot Project Brief - Rhode Island Quality Institute</a> (<a class="wiki_link" href="http://wiki.directproject.org/RIQI+Pilot+Shared+Documents">shared documents</a>)<br />
<a class="wiki_link" href="http://wiki.directproject.org/Pilot+Project+Brief+-+Medical+Professional+Services+%28MPS%29">Pilot Project Brief - Medical Professional Services (MPS)</a><br />
<a class="wiki_link" href="http://wiki.directproject.org/Pilot+Project+Brief+-+MedAllies">Pilot Project Brief - MedAllies</a> <a class="wiki_link" href="http://wiki.directproject.org/MA+Shared+documents">(Shared Documents)</a><br />
<a class="wiki_link_new" href="http://wiki.directproject.org/NHIN+Direct+-+Pilot+Project+Brief+-+CareSpark" style="color: #660000;">Pilot Project Brief - CareSpark </a><br />
<a class="wiki_link" href="http://wiki.directproject.org/Pilot+Project+Brief+-+Redwood+MedNet">Pilot Project Brief - Redwood MedNet</a><br />
<a class="wiki_link" href="http://wiki.directproject.org/Pilot+Project+Brief+-+VisionShare+and+Public+Health">Pilot Project Brief - VisionShare and Public Health</a></span></span>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-7701710620420989232010-10-26T10:29:00.000-07:002010-10-26T10:29:00.375-07:00Fuel Cell EvaluationEver since 60 Minutes profiled Bloom Energy I've been interested in using fuel cells to generate electricity, particularly in commercial use (versus auto, residential, and industrial). While the buzz around Bloom Energy is compelling and many in the blogsphere trumpet the future of Bloom, I've remained unconvinced - I've had a number of nagging worries.<br />
<br />
I came across this <a href="http://www.cityofseattle.net/light/news/issues/irp/docs/SCLIRP2010_Appendix_I.pdf">analysis </a>for the Seattle WA region public utility that confirmed many of my concerns - without the substantial CA State and Federal subsidies, Bloom isn't viable and it's not clean enough when compared to other renewable energy sources.<br />
<br />
<blockquote><blockquote>At this time, there is no compelling reason for City Light to pursue any interests in solid oxide fuel cell systems. Bloom Energy has the only commercially available system, the ES-5000 Energy Server, and it is available only to facilities located in California with very specific energy requirements. This narrow market focus parallels the structure of major subsidies from state and federal taxpayers and utility ratepayers. (Seattle City Light 2010 Integrated Resource Plan, Appendix I, pg 4)</blockquote></blockquote>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com1tag:blogger.com,1999:blog-8879754027589495838.post-62383913370968791442010-08-25T06:40:00.000-07:002010-08-25T06:40:14.213-07:00Generating Personalized Forms / Documents<span class="Apple-style-span" style="font-family: Arial;">Have you ever needed to create forms that would be personalized, much as you might with Microsoft Word's mail merge feature, but wanted to do so in an automated fashion? There's many solutions to that requirement, but here's one I like.</span><div><span class="Apple-style-span" style="font-family: Arial;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial;">OfficeWriter for Word from <a href="http://officewriter.softartisans.com/officewriter-186.aspx">SoftArtisans</a> provides that functionality. OfficeWriter is a Windows server application that starts with your Word Template and then performs variable substitution to create a Word-compliant .doc file (among other formats). And it does so without installing Office or Word on your Windows server. Therefor, OfficeWriter can generate 1,000s of Word files precisely to your requirements in a "lights-out" environment.</span></div><div><span class="Apple-style-span" style="font-family: Arial;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial;">Here's an example. Let's say that you need to generate outbound forms that will be filled-in by people who then fax back the documents to you for processing - order forms, registration forms, applications, and the like. </span></div><div><span class="Apple-style-span" style="font-family: Arial;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial;">With OfficeWriter, you can create your template form using Word on your desktop, then give OfficeWriter on your serve the template, configure your datasources and merge criteria, and the let it rip! OfficeWriter will create individual .doc files that have been customized with Names, Addresses, Order Quantities, etc. From there, you could hand the .doc files directly to <a href="http://www.captaris.com/rightfax/rightfax_9_3.html">RightFax</a>:</span></div><div><span class="Apple-style-span" style="font-family: Arial;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">“A new conversion engine converts documents to faxes on the RightFax Server from native applications such as Microsoft Word, PowerPoint, Excel and HTML. The new conversion engine … uses Microsoft .NET APIs to automate Microsoft programs.”</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">RightFax, in turn, will fax the converted .doc files to the appropriate fax numbers. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">After people make their corrections, updates, signatures to the faxed documents, they can then fax them back to the RightFax server.</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">A pretty slick way to begin automating a paper-based, manual process. It's a step in the right direction!</span></div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-55689105987454920712010-07-20T09:40:00.000-07:002010-07-20T09:40:05.682-07:00Automating Faxes - Turn-Around DocumentsRecently a prospect presented the following scenario:<br />
<br />
High number of facilities<br />
Fax is the current communication method between facilities and the lab<br />
Faxes are handled by humans at both the facilities and at the lab<br />
How can we improve our process?<br />
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The techniques described below can be put into practice in low volume situations as well.<br />
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While the ideal would be to eliminate faxes entirely with, for example, a web site or an email-technique, or, ideally, direct application integration, these techniques all require a change on the part of the faciltiy; something that is often too hard to accomplish.<br />
<br />
So, what can you do with faxes to improve the process through reducing labor effort and reducing errors?<br />
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Phase 1 (Fax Server)<br />
Implement a <a href="http://faxsolutions.opentext.com/fax-automation.aspx">fax server</a> at the lab. A fax server can send and receive faxes without a human handling the paper. <br />
<br />
At the lab, the fax server can be configured to receive fax as electronic files based upon the number that originated the fax. As an example, Facility A faxes from fax number A. When the fax is received at the lab by the fax server, the fax server detects that the fax originated at fax number A and therefor places the fax file into a directory accessed by the clerk that works on faxes from facility A. alternatively, the fax server can be configured to email the fax file to the clerk. Variations on this theme include uploading the fax file into a workflow system that automates the routing of the fax.<br />
<br />
At the lab, the fax server can be configured to send faxes to facilities, such as Facility A. An easy way to do this is through a "fax printer" accessible from the Windows Print environment at each desktop. This makes it trivial to "print" the lab results directly from the lab application and have the results, with a header page, fax out to Facility A. <br />
<br />
Phase 2 (Workflow)<br />
Implement <a href="http://www.vignette.com/dafiles/docs/Downloads/Vignette-Case-Manager-product-datasheet.pdf">case processing</a> at the lab. Case Processing quickly automates manual steps in a process. As an example, the inbound fax might contain an order for a single patient to perform multiple tests or it might contain multiple patients for the same test or a combination. Case Processing automates presenting to a human the fax and enabling that person to quickly key the correct test orders. It then can queue up the individual test into multiple testers queues in an appropriate priority order. When the tests are completed, the results can be matched to each of the orders, the orders assembled into a single fax, and the fax sent out to the correct facility.<br />
<br />
Phase 3 (OCR)<br />
Implement <a href="http://www.opentext.com/2/global/sol-products/sol-pro-capture-delivery/pro-capture-center.htm">Optical Character Recognition</a> at the lab to reduce the manual data entry from Phase 1 above. In particular, OCR can detect a facility identifier, the individual patient medical record numbers (MRN), and, if the fax form has been configured effectively, it could detect which tests to perform. In this way, the bulk of the work performed by a human in Phase 1 can be reduced. It can't be eliminated, because OCR always has errors that need to validated, but it can significantly reduce the human effort required.<br />
<br />
Additional techniques to improve the above include:<br />
<br />
1. use "comb" style hand-print constraints:<br />
<br />
Open comb fields (i.e. no line on top)<br />
o Cells must have a U shape (otherwise they might be recognized as an "L"<br />
o Tick marks in between characters must be of the same height but use a high mark to separate words or sections (SSN or date are good examples)<br />
<br />
2. provide "turn-around" documents whenever possible<br />
Turn-around documents are those that originate at the lab, sent to the facility, are adjusted by the facility, and returned. Examples might include a "orders approval" form that lists every lab to be performed for every patient. The key benefit of turn-around documents is that the lab has complete control of the placement of content on the form, as well as the ability to uniquely identify each page - this enables the OCR product to know what the form is exactly and then do the recognition of the text based on known locations for the content. Besides, the facility people will have to do less work.Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-2316828674204550942010-07-02T07:56:00.000-07:002010-07-02T07:56:40.603-07:00ONC's Temporary Certification Program (provider-focus)Today ONC conducted another teleconference to inform providers that have built their own solutions how they will be affected by the Certification Program.<br />
<br />
Carol Bean, Director of Certification<br />
Steve Pozniak, Director of Federal Policy<br />
<br />
<a href="http://healthit.hhs.gov/portal/server.pt">http://healthit.hhs.gov/portal/server.pt</a> has a listserv to inform us.<br />
<br />
Both Carol and Steve said basically the same as yesterday. See my previous post.<br />
<br />
Each ATCB must provide testing for onsite (at the ATCB's facility) and remote for both development and deployment sites. The deployment site is typically the Providers facility.<br />
<div><br />
</div><div>Adding functionality to your existing solution that has been certified does not require that you re-certify.</div><div><br />
</div><div>Questions & Answers</div><div><br />
</div><div><ol><li>What is an EHR Module?</li>
<ul><li>It's anything that meets at least 1 certification requirement. For example, a Problem List could be an EHR Module (thought it's unlikely). another example might be a List module (Problem, Medication, Treatment, etc) that too could be an EHR Module. </li>
</ul><li>We use both a complete EHR and self-developed software. Will we need to certify the self-developed software too?</li>
<ul><li>If you have a hybrid then you'll have to test and certify the self-developed software.</li>
</ul><li>Does previous CCHIT certification flow-on? Grandfather clause....</li>
<ul><li>No.</li>
</ul><li>What is the process for getting certified?</li>
<ul><li>That depends upon the ATCB.</li>
</ul><li>what if you've got 3 certified complete EHRs and you're using parts of each at different facilities. Is it sufficient that the 3 EHRs have been certified?</li>
<ul><li>A clear answer wasn't provided, in my view.</li>
</ul><li>Would self-attestation suffice?</li>
<ul><li>You'll have to check with CMS - incentive payment question.</li>
</ul><li>What testing methods are required?</li>
<ul><li>Testing methods approved by ONC.</li>
</ul><li>What if you're running previous version of certified EHRs or highly customized solutions, what certifications are required?</li>
<ul><li>Get your system certified.</li>
</ul><li>What kind of cost are we looking at?</li>
<ul><li>14 applications were sent out - it would be great if all of them achieved accreditation. </li>
</ul><li>Assuming the legacy environment and I get it certified, how long does the certification last?</li>
<ul><li>Let's say you get tested at Stage 1 (10 measures) and then we set Stage 2 (13 measures), you'll then need to re-certify.</li>
</ul></ol></div><div><br />
</div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-74484051797181998182010-07-01T14:07:00.000-07:002010-07-01T14:07:02.601-07:00ONC's Temporary Certification Program<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Today, ONC hosted a telephone conference to update Health IT Developers and Vendors of EHR technology on the </span><a href="http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=2886&PageID=19629"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: black;">Temporary Certification Program</span></span></a><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">. </span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The temporary rule has been published as updates to 45 CFR Part 170 (HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY) </span><span class="Apple-style-span" style="line-height: 28px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.blogger.com/goog_1206885699">Robin Raiford bookmarked the</a></span></span><span class="Apple-style-span" style="line-height: 28px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.blogger.com/goog_1206885699"> </a></span></span><span class="Apple-style-span" style="line-height: 28px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: black;"><a href="http://mycourses.med.harvard.edu/ec_res/nt/D365EA11-35C3-4CD7-86BC-B517562535AA/certfr.pdf">Federal Register version</a></span></span></span><span class="Apple-style-span" style="line-height: 28px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">.</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The speakers were:</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Carol Beam, Director of Certification and Testing, ONC</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Steve Posnack, Director of Policy, ONC</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The rules serve two purposes:</span><br />
<br />
<ol><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Established the process for the National Coordinator to select ONC's </span><span class="Apple-style-span" style="line-height: 19px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Authorized Testing and Certification Body</span></span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"> (ATCB)</span></li>
<li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Set some of the parameters around the testing itself.</span></li>
</ol><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">This rule paves the way for vendors to get their products tested and certified.</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Some of the parameters around testing include:</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Section 170.420 - the Principals of Proper Conduct</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ATCBs must support testing of both developed and deployed solutions</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">170.445 & 450</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">ATCBs must also support testing of both complete EHRs and EHR modules.</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The following were questions posed by the audience.</span><br />
<br />
<ol><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What is a new version? (ie does a bug release constitute a new version)</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">If an EHR developers defines it as a new release, then they will require a new certificate.</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">How does a customer claim certification? (ie do they have to provide some sort of proof of sale / license)</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The Certified Health IT Product list will be managed by ONC and that website will be the source of truth. For Meaningful Use reporting, a unique identifier will be assigned to each bundle of products that in combination achieve Meaningful Use requirements.</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What if a solution is offered both bundled and un-bundled?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">There will be unique identifiers for each (bundled and un-bundled). ONC will not be testing whether they are actually being used - that's a function of the audit (CMS).</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What bodies will provide oversight of both the ATCB and the developers?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">in the temporary program, ONC will provide oversight of ATCB (adhere to the Principals of Proper Conduct)</span></li>
<li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">in the permanent program, vendors will be subject to a post-market surveillance program</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What will the certification cost?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">CCHIT had presented potential pricing ranges - we generally used those as our estimates. We're hoping that the competitive environment that we hope we've created will reduce those costs.</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Will there be a "seal" of certification?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">We require that the ATCBs tell the developers to convey to prospective purchasers and customers: product name, date of certification, certification number, etc. We don't specify a particular image.</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What about Clinical Quality Measures?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">When a product is ready to be certified, the measures will have to have been published.... Stay tuned.</span></li>
</ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">What about additional software that may be required?</span></li>
<ul><li><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The additional software will have to be identified and listed.</span></li>
</ul></ol>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-78447792869152417512010-06-29T05:12:00.000-07:002010-07-01T13:01:52.054-07:00Linking your ECM solution with your EMRRecently I worked with Steve Sawyer from the <a href="http://www.mayohealthsystem.org/mhs/live/page.cfm">Mayo Health System</a> to produce a webinar in which Steve discusses why Mayo decided to acquire an ECM system and then to link it to their enterprise EMR. Steve's done some remarkable work and Mayo, though only about a quarter of the way through their enterprise deployment, has begun to achieve good returns. Most importantly, the docs like the solution!<br />
<br />
<a href="http://campaigns.opentext.com/forms/2010-Q2-AM-BO-WD-FM-OT-HCCaseStudyMayo">Register to watch the webinar.</a>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-29451183684077354402010-06-28T07:42:00.000-07:002010-06-29T14:08:56.365-07:00Leadership is hard workGeneral McChrystal has been fired. I have to admit that I was stunned to read his <a href="http://www.rollingstone.com/politics/news/17390/119236">remarks in Rolling Stone</a> - they reflect very poorly on his leadership; which is a shame, given his remarkable performance in the past. <br />
<br />
<br />
As a staff officer, I often commiserated with my peers and with my subordinates about our higher-ups - we often used the phrase Echelons Above Reality to refer to our higher-ups, which was a play on the phrase EAC (<a href="http://en.wikipedia.org/wiki/Echelons_above_Corps">Echelons above Corps</a>) . And we often had much harsher phrases for individuals that were in staff and sometimes command positions above us. I've seen that kind of behavior in commerce, government and the military so I think it's fairly common.<br />
<br />
<br />
As a commander, however, the situation was much different . Everything you do, everything you say, everything you write, and all the body language you send out is scrutinized, evaluated, assessed, and probed. It's the nature of the job. As a consequence, I was extremely careful about what I said, when I said it, how I said it, to whom I said it, and the body language I presented. And I'm not a 4-star general.<br />
<br />
So, was General McChrystal being immature? Was he somehow caught off-guard? <br />
<br />
Or, did he do as I did: prepare ahead of time for every encounter and go into every encounter with a plan to achieve a specific outcome?<br />
<br />
My thinking is the later - he knew what he was doing and very specifically chose to do what he did. <br />
<br />
What I can't figure out is why? What was he planning on achieving?Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-66395205965122580732010-06-18T13:14:00.000-07:002010-06-21T14:58:53.373-07:00How to use eSignature with your EMR and your DM systemeSignature is a term that refers to applying some sort of signature to an electronic document.<br />
<br />
One illustration of eSignature is when a physcian reviews and approves an electronic document - perhaps a progress note that has been scanned and linked to a patient encounter. <br />
<br />
There are several common requirements:<br />
<br />
1. an audit trail must be retained that provides access details regarding changes to the document, including the signature. Usually this audit trail will provide user and date / time stamps for each action taken with the document. For example, when a physician affixes his / her signature to the document, the physician's details and date / time are recorded.<br />
<br />
2. the original document needs to be altered in both a visual and a physical manner. Often the signature is a text string, "Approved and digitally signed by John Smith, MD on June 18, 2010 at 1:07 PM ET." and the text is over-layed at a selected location on the document image; thus, visually the document has been altered. Next, a new document is created that "burns' the signature into the image, permanently changing the image with the signature.<br />
<br />
3. the workflow associated with applying the signature varies but in general follows: HIM analyst identifies who needs to approve / sign the document and where on the document the signature needs to be placed. Next, the document is routed to those that need to review & sign. The people that need to do the reviewing / signing are presented with options (approve / sign, reject) and make their selection. Those that have been approved for signature are then signed and a new document created with the signature. Finally, references to the unsigned-document are translated so that only the new, signed document is returned to users.<br />
<br />
In terms of integrating the eSignature capability among multiple systems, usually an EMR for the user interface and a DM system for managing the documents, I recommend that you rely on the EMR's workflow to manage user interaction. The key reason for this approach is that the EMR provides a consistent UI for the most critical user - the doctor. There are other reasons too (such as the EMR typically implements a role-based security model and it usually has a chart deficiency module to control the workflow), but not having to train the doctors is essential.Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-29306128868568191842010-05-14T07:35:00.000-07:002010-06-01T14:34:11.769-07:00Document Management in HealthcareWhat is Document Management?<br />
<br />
For a variety of definitions from the Web, click <a href="http://www.google.com/search?hl=en&safe=off&q=define:+Document+Management&btnG=Search">here</a>.<br />
<br />
I like examples to illustrate definitions so here's mine from heatlhcare.<br />
<br />
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 <br />
<br />
<ul><li>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</li>
<li>medical laboratory results from tests perfomed due to physician orders</li>
<li>prescriptions ordered</li>
<li>medical histories, often completed jointly by the patient and a nurse or the physician</li>
<li>and similar content.</li>
</ul><br />
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.<br />
<br />
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 <a href="http://www.aafp.org/fpm/2007/0400/p44.html">thousands</a> 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.<br />
<br />
Put another way, doctor's offices have thousands of paper folders stuffed with paper.<br />
<br />
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. <br />
<br />
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.<br />
<br />
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 <br />
<br />
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.Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-21789490331274237072010-05-07T12:08:00.000-07:002010-06-01T14:35:59.456-07:00Paper Patient Charts in Remote PracticesAs hospitals continue their EMR implementations, they often recognize that they need to address the paper that's in their remote clinics and practices: ie what to do about the paper patient charts in the practices? <br />
<br />
<div></div>In brief, the following are commonly used:<br />
<ul><li>do nothing - leave the paper charts at the practice</li>
<li>pack and ship the charts to a central scanning and indexing facility (often at the hospital or nearby and sometimes a third party that specializes in scanning and indexing)</li>
<li>use staff at the practice to do the scanning and indexing</li>
<li>send a mobile team to the practice to do the scanning</li>
</ul><br />
<div></div>My preference is the mobile scan team and here's why. <br />
<br />
<div></div><span style="font-family: Verdana, sans-serif; font-size: large;">Scanning is Process Manufacturing</span><br />
While scanning and indexing isn't really hard work, to do it well requires people that like to do it. Think of scanning as process manufacturing that starts with raw materials (a paper chart) and after processing produces perfectly indexed images inside of an EMR system. The process includes<br />
<ul><li>document preparation - removing paper from the chart, taking out staples and paper clips, repairing paper tears, and taping small pages to 8x11.5 paper.</li>
<li>batch preparation - insert document separators to segregate individual documents. The most common technique is to use barcodes to identify each document type (progress note, lab result, discharge summary etc)</li>
<li>scanning - feeding batches of documents through a scanner</li>
<li>indexing - adding attributes to each of the documents such as MRN, Date of Service, Provider ID, Facility Code, etc</li>
<li>QA - confirming that the image quality is acceptable</li>
<li>commital - sending the documents to the ECM system</li>
</ul>People that like to do document preparation are essential to creating high quality images in the EMR while people who take pride in their accuracy will prevent misfiles and rework. Do you have those kinds of people at your remote practices with the time to do chart scanning?<br />
<br />
Scanning Requires Specialized Equipment<br />
While the price of scanners has come down, there remains a significant price for performance. Here's how to think about it: if the scanners is running, then paper charts are being converted to images. If the scanner breaks down, charts are not converted. My recommendation is to always buy 2 scanners and as operators become proficient whith those scanners, keep the scanners running. Let the rate at which the scanner scans become the throttle to your process: add staff to document preparation and indexing / qa to accomodate the throughput of your scanners. <br />
<br />
Additionally, you'll likely want to have tools that make document and batch preparation more efficient such as "spear-type" staple removers, solid scotch tape dispensers, document and batch separators, and so on.Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-20112445065439177502008-11-13T13:24:00.000-08:002008-11-13T13:26:02.491-08:00Is this how one does URLs?I found the 'link" icon in editor so here goes: <a href="http://improving-nao.blogspot.com/">Phil's Blog</a> . Let's see how it looks!Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-21734882458200885082008-11-12T09:58:00.001-08:002008-11-12T09:59:21.082-08:002nd postI see that the URL to Phil's blog didn't work. I'll try again:<div><span class="Apple-style-span" style="color: rgb(51, 51, 51); font-family: Verdana; line-height: 17px; "><span class="Apple-style-span" style="font-size: medium;">http://improving-nao.blogspot.com/</span></span><br /></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); font-family: Verdana; font-size: 11px; line-height: 17px;"><br /></span></div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0tag:blogger.com,1999:blog-8879754027589495838.post-13052372419967145862008-11-11T14:14:00.000-08:002008-11-11T14:22:13.711-08:00first postI'm sitting at DIA wondering why there's so much interest in blogs? I've only read Phil Ayers blog a handful of times, http://improving-nao.blogspot.com/, and haven't really spent much time looking at other blogs. Nonetheless, I'm thinking it's time. So. this is my chance to jump in :)<div><br /></div>Joe Stewarthttp://www.blogger.com/profile/07241746680686110749noreply@blogger.com0