The Future of Documents

 The Stimulus package is definitely a great incentive for getting small practices and large hospitals to move towards Electronic Medical Records – despite a pretty high upfront cost of around $44000 per physician to install a new electronic health-record system. Daily Finance has an interesting article and interview on a new trend: ad-sponsored online health records.

Practice Fusion, a small start-up, has an interesting approach of making that service free but ad-sponsored. Their software is web- and cloud-based (partners of Salesforce.com), meaning doctors don’t have to worry about setting up the software. Even better, it can be free, provided doctors agree to have ads appear on their record system.  Practice Fusion provides interesting capabilities, like automatic charting, patient management, ePrescription, scheduling and billing.

One thing that leaves me a bit uncomfortable with many of these proposals is the gap between past and present (paper) and future (full digital), and the deliberate avoidance of the hardest problem - getting legacy paper records accessible in the new system. Sure, new paper documents can be scanned and imported as images, but what about the legacy volume of documents still sitting in folders? How can you extract and inject them into an electronic Medical Record system, while making sure this information can be searched, accessed and retrieved easily?

I visited one of our customers recently, who has a huge warehouse of over a million Medical Records folders -  scary experience, especially when thinking that my life might depend, one day, on the speedy access to the right information contained in that 200 pages folder, sitting with another million folders …

So how do you intelligently scan the legacy medical record and recreate an intelligent, electronic version is navigable, searchable, and brings as much information to the doctor -and hopefully more- as the physical paper record? That is, to me, the toughest problem. I’ll be touching on some of these aspects in the future.

Good coverage by CNET.com on Your e-health future. It touches upon some of the rationales for moving Medical Records to Electronic formats – but also alludes to the major barriers, including cost, complexity, privacy, and security (and less obvious ones, such as the legal use of digital health records by insurance companies to deny membership or hike prices beyond affordability for those with existing medical conditions), while talking about the trends and regulations that affect this trend.

Interesting reading that I’ll let you discover by yourself, but in my opinion one of the main point is the mention that the advantages of electronic medical records come only if older paper records are scanned or incorporated into the new system.

This is a laborious, expensive and error-prone process, which requires technologies like Automatic Classification, Intelligent Extraction, and other advanced technologies that can extract information from this unstructured set of information. And, scanning this huge backlog of information should not be improvised - can I scan all of those records at once? Or should I scan a patient record only in preparation of an appointment, on-demand? What about all this paper trail that we’ll continue generating until Medical Records become fully electronic?  Should I use decentralized scanning, bulk scanning, or a mix of both? TYhis can of strategy is best defined with an expert in document management, who can put you on the path to the Less Paper medical office.

One of the important benefits of turning your health records documents into digital is the fact that, if done properly, they can be indexed with metadata (extracted automatically or not) and full-text searchable.

As this interesting CNN article points out, going paperless or at least “Less Paper“ has benefits beyond search and retrieval. Natural Language Processing or “Document Mining“ will allow the automatic “mining” of your documents, and make them fully semantic. This will allow not only to find the medical terms in it contains, but also how they interrelate, to provide an automatic analysis and “understanding” of facts in that document – and that will allow a vastly improved quality of service, the system having analyzed your patient record to provide a more informed diagnosis by your doctor and avoiding potential errors.

It does sound like science fiction – but it’s not that far away, in fact. IBM research is mentioned in the article, but researchers at Xerox and elsewhere are actively exploring the problem of “mining” patient records owing to technologies such as FactSpotter.

Business Week has a very interesting article on the benefits of less paper, or even paperless, in the Health Industry. Kaiser Permanente is cited as a role model for removing paper out of their offices, and moving towards eHealth records.

Interestingly enough, cost is not necessarily the main driver, as they admit that “there is unknown, if any, cost savings benefits”. However, other benefits accrue through improved productivity, and less redundant operations because of informaiton retained in paper records. However, at the end of the day, these will translate into cost savings anyway, as well as a more environmental-friendly behaviour. Not to mention improved quality of service – invaluable to the patient, with more up-to-date information.

Unfortunately, those players that have to make the biggest investments (small practices of doctors) are not the ones that reap most of those benefits – most typically the patient, hospital, health plan, and pharmacists. The up-front cost of establishing a eHealth record for small practices is still quite prohibitive, and the disruption in their work processes is quite significant at first. Only 4% of physicians have a comprehensive system in place, and another 13% use basic electronic system.

Even doctors in hospitals have a steep learning curve – only capable to receive half their normal patient load for the first two weeks, because of disruptions due to the electronic system . But this gets back to normal after a few weeks, usually.

The Health industry, like many others, can really benefit from a Less Paper strategy -  also productivity improvements, quality of service, and many other benefits – which eventually turn into significant cost reductions. This is usually best achieved by getting help from an expert – capable of re-engineering your business processes, and minimizing disruption.