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Changing Trends In Healthcare Information Management and Electronic Health Records

TableofContents
POSITIONINGSTATEMENT PRESIDENTIALPROPOSALS2008ANINDICATOROFTHINGSTOCOME THEDYNAMICNATUREOFHEALTHCAREINFORMATIONMANAGEMENT.. EXISTINGANDONGOINGINITIATIVESINHEALTHCAREINFORMATION MANAGEMENT THECHANGINGTRENDSINHEALTHCAREINFORMATIONAND MEDICALRECORDSMANAGEMENT............................................................................... ALOOKATADVANCEDMEDICALRECORDSMANAGEMENTSYSTEMS................. BENEFITSOFADVANCEDHEALTHINFORMATIONMANAGEMENTSYSTEMS...........
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INTENDEDTECHNOLOGIES,WORKFLOWSANDPOLICIESTHATWILLDRIVE ADVANCEDMEDICALRECORDSMANAGEMENTSYSTEMS. CONCLUSION

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Positioning Statement
Withtechnologicaladvancements,HealthcareInformationManagementandElectronichealth recordsystemshaveundergoneaseachangeovertheyearsandwhatisevenmorenoteworthy isthattheevolutionarypaceisexpectedtoaccelerateevenfurtherinthecomingyears.The increasingdynamismofthesecriticalsystemsbecomeseasilyevidentwhenyoulookattheuse ofadvancedtechnologiessuchastheComputerizedPhysiciansOrderEntry(CPOE)and ElectronicMedicalRecordssystems.Theseadvancedtechnologiesarebeingdeployedwitha viewtoimprovetheefficiencyofpatientinformationmanagementsystems,somethingthatwill enablehealthcarecenterstodeliverthebestpossiblecareandtreatmenttopatients. Inthenearfuture,theimmediatebeneficiarieswillbepatientsandhealthcareprofessionals. However,thecompletelistofbeneficiarieswillnotbelimitedandwillcertainlyincludeothersas wellsuchastheinsuranceandlegalentitiesthatneedmedicalrecordsverificationsonaregular basis.Conversionofallpaperbasedmedicalrecordsintoelectronicformwillhelpinsuranceand legalfirmshaveaccesstorequiredinformationattheclickofthemouse.Thiswillimprovetheir operationalefficiencyandallowthemtodeliverpromptservicestotheirclients.Thelistof beneficiarieswillalsoincludebusinessprocessoutsourcingcompanieswithexpertiseinmedical recordretrievalandverificationandotherrelateddomains.Benefitstothesecompanieswill accrueintheformofincreasedworkordersasisexpectedwhenhealthcarecentersmakethe dramaticshiftofconvertingalloftheirmedicalrecordsintoelectronicform. Thisreportwilldiscussthebestpracticesthathealthcarecentershaveemployedforeffective managementofmedicalrecords.Itwillalsotrytoascertaintheoptionsthatmightbeavailableto healthcareandalliedservicesectorsformakingthefinaltransitiontoelectronichealthrecord systemsandrealizingthebenefitsthereon.Apartfromthese,thereportwillexamineallthe variousfactorsthatwillultimatelydeterminethesuccessofcompletedigitizationofmedical records.Thesefactorsarerelatedtostudyingtheimpactofincreaseddigitizationonexisting workflows,theabilitytomergephysicallydispersedmedicalrecords,andtheabilityto incorporatenewtoolsandsystemsthatmightbecomeavailableintheyearstocome.

Presidential Proposals 2008 An Indicator of Things to Come

Presidentialproposalsareanindicatorofthingstocomeandwithtwooftheleadingpresidential contendersraisingtheirvoicesinsupportofincreaseddigitizationofmedicalrecords,itwould notbewrongtoassumethathealthcareinformationmanagementwillundergodramatic transformations.BothJohnMcCainandBarackObamahavepledgedbothfinancialand statutorysupportforthecompleteautomationofmedicalrecords.Thisisbeingdonekeepingin mindthegrowingconcernsovermedicalerrorsandlapsesthathavebecomequite commonplacenowadays.Notallpresidentialproposalsseethelightoftheday,butconsidering thehugesupportthatproposalsrelatedtoelectronicmedicalrecordshavegenerated,it'shighly unlikelythatpresidentialcandidateswillbackdownoncetheyarefinallyinapositiontoconvert theproposalsintoactuallaw.Whentheseproposalsfinallygetlegalandstatutoryrecognition, benefitswillaccrueintheformofimprovedmedicalcareandoperatingefficiencyandtheability tointegratenewtechnologybasedsolutionsassoonastheymightbecomeavailable.

The Dynamic Nature of Healthcare Information Management

IntheUnitedStates,healthcareandalliedsectorsarecountedamongstthemostcomplexofall economicsectors.Itisestimatedthathealthcareandalliedsectorsnowcontributearoundfifteen percenttotheGDP,somethingthatmakesitquiteclearastowhypresidentialcontendersare focusingontheneedtoimproveexistinghealthcaresystems. Presently,HealthcareInformationManagementiscertainlynotaneasytaskbecause voluminousamountsofdata,bothpaperbasedandelectronic,aregeneratedbyhealthcare centers.Mostproblemsrelatetotheprocessing,storage,andretrievalofpaperbasedmedical records.Itisestimatedthatforeveryhourspentonpatientcare,healthcarecentershaveto spend30minutesonadministrativepaperwork.Theproblemgetsevenmorecomplicated becausehealthcarecentersalsoneedtocompilediagnosticdataandtestresultsasare normallyorderedbyphysiciansandpathologists.Apartfromthese,useofadvanced technologiessuchasMRIscans,PETscans,ComputerTomographyandothersareaddingto thecomplexityandvolumeofpaperbasedmedicalrecords. Forresolvingsuchissues,healthcarecentershavenowstartedchoosingIntegratedDelivery Networks(IDN)thatprovidethenecessaryintegrationbetweenallthoseinvolvedsuchas healthcarecenters,physicians,hospitals,suppliers,researchers,clinicaltestcenters,third partiesandofcoursepatients.WithIDNs,thedistributionandsharingofcriticaldataand informationbetweentheinvolvedpartieshasbecomealoteasier.Thewholeprocesshasalso becomealotfasterandcosteffectivenow.ThereliabilityandeffectivenessofIDNsbecomes evidentwhenyoulookattheincreasingnumberofhealthcarecentersthathavechosenitand themanythatareintheprocessofdoingso.Aresearchsurveyconductedrecentlyfoundout thataround99.98%ofthehealthcareprofessionalswhowereinterviewedwerewellawareof theneedtoimprovemedicalcarequalityandefficiencythroughIDNs.

Existing and Ongoing Initiatives in Healthcare Information Management

Onthenationalleveltoo,manydifferenthealthcareinitiativeshavebeenlaunchedinthepast, mostofthemtargetingimprovementsinhealthcareinformationmanagement.Themost importantamongsttheseistheHIPAA,introducedin1996.ShortforHealthInsurancePortability andAccountabilityAct,thisactwasintroducedwithaviewtosafeguardtheprivacyandsecurity ofpatientinformationandrelateddocumentations.TheActalsocoversrelatedtransactionssuch asmedicalinsuranceeligibility,insuranceclaims,documentationneeds,referralsandrequired authorizations.SomethingthatisevenmorenoteworthyaboutthisActisthatitprovidedthe requiredframeworkforsecuredigitizationofmedicalrecords.Thiswasdonethroughmandated prerequisitesandregulationsdealingwithhealthplans,insurancefirms,healthcarecenters,and electronicdatatransactions.

Inshort,itcanbesaidthattheActlaidthefoundationforanationallevelhealthinformation infrastructureandelectronichealthrecordsystems.Overtheyears,HIPAAhasprovedhighly successfulandthisiswhytheFederalgovernmentisnotlettinguponitseffortstoachieveeven greaterefficienciesinhealthcareinformationmanagement.

The Changing Trends in Healthcare Information and Medical Records Management

TheshifttoElectronicHealthRecordshasalreadytakenoffinabigway,buteventhenthereis plentythatneedstobedone.Thisisbecausethetaskathandisquitehugeandcanonlybe completedifthenecessaryfinancialandlogisticalsupportismadeavailabletoalloftheinvolved parties.However,nobodyisshowingsignsoffatiguebecauseitisbeinganticipatedthatwhen theshifttodigitizationisover,itwillresultinhugesavings,ashighas$140Billioneveryyear. Savingsthatareashighastenpercentofthetotalnationalhealthspendingprovidesenough motivationandencouragementtoallthoseinvolved. Withincreaseddigitization,ithasnowbecomeeasiertomanagemedicalrecordsthathave becomemorecomprehensiveandincludeeverythingfrompatientinformationtodiagnosticcare andprescriptiondata.Asofnow,electronicmedicalrecordsarebeingusedforawidevarietyof purposessuchasforgettingmultipleviewsondiagnosticcareandtreatment,forassessing preventivemeasuresforvariousillnesses,andforassessingtheoutcomeofclinicaltrialsand research.Theyarealsobeingusedforassessingeligibilityforhealthinsuranceplans,claims settlements,andfinanciallending.Apartfromthese,electronicmedicalrecordsarehelping medicalresearchorganizationstokeepataboncommonailmentsandtheirprevalencein specificareassuchascounty,state,nationalandinternationallevels. Withmandatedpoliciesonstoring,accessing,sharinganddistributingelectronicmedical records,themedicalrecordsmanagementcostshavecertainlyincreased.However,not everybodyiscomplainingbecausetheoverallvalueofderivedbenefitsfarexceedsthecosts. Moreover,sincetheoptiontoreducecoststhroughoutsourcingmedicalrecordsretrievaland verificationisalwaysavailable,therehasnotbeenmuchhueandcryovertheincreasing dependenceonelectronicmedicalrecords.

A Look at Advanced Medical Records Management Systems

Voluminousamountsofdataandinformationhavealreadybeenconvertedintoelectronicform, butincomparisontodataandinformationthatisstillonpaperbasedmedicalrecords,it'sstill minuscule.Accommodatingdifferentdataformatsintothesamesystemhasthusbecomethe needofthehourandeveryoneseemstobeworkinghardondevelopingnewer,advanced medicalrecordsmanagementsystemsthatcanhandletheincreasingcomplexity.Itis anticipatedthatwhendeveloped,theseadvancedsystemswillpersistformanyyearstocome, becauseconvertingcompletelytoelectronichealthrecordmanagementisnotsomethingthat canbeachievedinweeksandmonths. Whendeveloped,theseadvancedsystemswillberequiredtointegratewithemergingelectronic datamanagementsolutionsandworkinaccordancewiththeexistingstatutorypoliciesand guidelinesrelatedtohealthcarerecordsmanagement.Theywillberequiredtobeflexiblesothat proceduralchangesintherecordsmanagementcanbereviewedandincorporated.Such changesaremostlikelytorelatetoworkflows,documentationcontrol,reportingcapabilities, securestorageandretrievalofrecords,andsharinganddistributionpolicies.Tobeableto satisfyalloftherequirementsdescribedabove,advancedhealthcareinformationmanagement systemswillberequiredtohavethefollowingcapabilities.

1 Shouldhavetherequisitescalabilityforhandlingvariedinformationtypesand increasedvolumesthatmayariseduetonewerpartnershipsenteredwithother healthcareorganizationsandthirdparties. 1. Shouldbeaccessible24/7overwideareanetworks(WAN)ortheWorldWideWeb, makingitpossibleforgeographicallydispersedconstituentstohaveaccessto requireddataattheclickofthemouse. 2. Shouldbeabletostorehealthcaredataandinformationalongwiththeirdetailed descriptions(metadata)sothatuserscanknowwhatisactuallythereinsidethe recordswithoutactuallyaccessingtheinformationcontained.Justbylookingatthe descriptions,userscandeterminewhetherornotamedicalrecordcontainsdataand informationthattheyarelookingfor. 3. Shouldhavefailsafelogcomponentsthatcanrecordeveryaccessgainedintothe systemanddataandinformationthatwasaccessedorcopiedfromthesystem.Log fileswillhelpinprovidingaccurateaudittrailsandcomplyingtorequirementsas statedintheAccountingofDisclosures. 4. Shouldhavebuiltinlogicalparametersthatcandetectunwanteddataandremoveit intelligentlyfromthesystem.Thiswillmakeiteasiertomanagetheeverincreasing volumeofdataandinformationcomingintothesystem.

Benefits of Advanced Health Information Management Systems

Itisestimatedthatcompleteautomationofmedicalrecordswillrequireatleasttwomore decadesandtillthenhealthinformationmanagementprofessionalswillhavetomanageboth physicalanddigitalfilesystems.Nowthiscertainlylookslikeabigproblem,butinrealityitisnot becausehealthinformationprofessionalscanalwayschooseadvancedhealthinformation managementsystemsthatmakeitquiteeasytomanagedifferentfilesystemsinparallel.Using theseadvancedsystems,professionalscansaveasignificantpercentageoftheiravailable productivetimeanduseitforothermoreimportanttaskssuchasresolvingoperationalproblems andissuesrelatedtomedicalrecordsmanagement.Usingtheseadvancedsystems, professionalscanmergevariedrecordlibrariesintoasinglecohesivesystem,allowingeasyand faststorageandretrievalofmedicalrecords.Thesesystemswillalsohelptosmooththe transitiontoelectronichealthrecordsandallowprofessionalstomanageintegratedfile repositoriesfromacentralizedlocation. Therearemanyotherbenefitsthatcanbederivedfromadvancedhealthinformation managementsystems.Fromthepatient'spointofview,thebenefitswillrelatetotheimproved qualityofmedicalcareandtreatment.Medicalerrorsmaystillcontinuetoplaguepatients,but consideringtheaccuracyandefficiencyofadvancedhealthcareinformationmanagement systems,itwouldnotbewrongtoassumethattheoccurrenceofmedicalerrorswillinfact becomeararity.Quickandhighlyaccurateretrievalofmedicalrecordswillthenautomatically resultinimproveddiagnosticandmedicalcare,reducedmedicalcostsduetofasterturnaround times,andincreasedphysiciansatisfaction.Healthcarecentersandprofessionals,information managementprofessionals,andotherrelatedthirdpartiesalsostandtobenefitintermsof lesserworkload,quickerbillingcycles,reducedaccountreceivables,andreducedoperational costs.Byprovidingquicksearchoptions,advancedhealthcareinformationsystemswillalso helpsavetheavailableproductivetimeofhealthcareinformationmanagementprofessionals. Evenmorebenefitscanbederivedifhealthcareinformationmanagementrelatedtasksare outsourced.Whenthisisdone,medicalrecordswillgettransformedintovaluableassets,which canthenbeusedforrevenuegenerationpurposes.Insurance,legalandfinancialentities regularlyneedtosourcemedicalrecordsoftheircustomers,somethingthathasalreadybeen madeintoarevenuegenerating,highlyprofitablebusinessmodel.Revenuesandprofitscanbe maximizedifthecurrentbusinessmodelisstandardizedusingadvancedhealthcareinformation managementsystems.

Astheregulatoryenvironmentbecomesmorecomprehensiveandasnewerpublichealth policiesandinitiativesarechalkedout,advancedhealthcareinformationmanagementsystems willmakeiteasiertoincorporatethesechangesintotheexistingsetup.Bymakinginformation availablethroughsecure,highbandwidthdatatransmissionlines,thesesystemswillalsohelpin speedingupdataretrievalandmaintainingthehighestaccuracylevels.Improvedmanagement ofelectronichealthrecordswillhelpmitigatelegalrisksandalsoenablebettercompliancewith centralizedhealthcareinitiativessuchassurveyingthepotentialspreadofcommunicable diseasesandresearchingtheirprobableremedies.Allthiswillautomaticallyresultinimproved diagnosticsandtreatment.

Intended Technologies, Workflows and Policies That Will Drive Advanced Medical Records Management Systems
Technologyhasalwaysplayedanimportantroleintheevolutionofelectronicmedicalrecords management.IthasmadeiteasierforhealthplannerstoimplementstandardssuchasHL7and DICOMaswellaslegislationssuchasHIPPA.Allofthesetogetherhavehelpedinfosteringa favorableenvironmentasisnecessaryforintegratingallthevarioussystemsandconstituents associatedwithhealthcareinformationmanagement.Inthecomingyears,evenhigher standardswillbedefinedforhealthcareinformationmanagementandasalways,technologywill bethekeytothesuccessofachievingthosehighstandards. Formakingthebestpossibleuseoftheirproductivetime,healthcareinformationmanagers shouldlooktoadvancedtechnologiesthatarealreadyavailable.Forbestresults,theyneedto relyonintelligenttechnologyplatformsthatcanautomaticallyidentifyerrorsandeliminatethose fromthesystem.Havinginbuilttechnologiesthatcanintelligentlydetectirrelevantand unnecessarydataandinformationwillbeanaddedadvantage. Apartfromtechnology,comprehensivemedicalrecordsmanagementwillalsorequirewell thoughtoutpoliciesandworkflows.Effortsonthisfronthavealreadystartedandquitealothas alreadybeenachieved,butsuchisthecomplexityofmedicalrecordsthatthereisstillplentyleft tobedone.Asinformationsystemsbecomeincreasinglycomplex,workflowmanagersand policyplannersmayhavetositdowntogethertoplanthemostfavorableguidelinesfor healthcareinformationmanagement.

Withtime,theeasyavailabilityofhealthcareinformationattheclickofamousewillfueleven moredemandforeasilyaccessiblemedicalrecords.Iftheexistinginfrastructureisnot upgraded,itwillslowdownthesystemandrenderitineffective.Assuch,whatisneededis constantinfrastructuralupgrades,keepinginmindtheincreasingdemandforonlinemedical records. Formakingacompleteswitchovertoelectronichealthrecords,informationmanagerswillbe requiredtomergearchived,paperbasedrecordswithexisting,ongoingtreatmentinformation thatwouldmostprobablybeinelectronicform.Assuch,medicalrecordsarchivalandretrieval systemswillberequiredtohaveflexibilityofoperationsandtheabilitytoaccommodatepotential changesandincreasedworkload.

Conclusion
Asofnow,thehealthcareinformationmanagementsectormayhavetocontinuewithpaper basedandfilmbasedmedicalrecords,butjudgingbythepaceofelectronichealthrecords management,itwouldnotbewrongtoassumethatthetargetedcompleteswitchoverwill happensoonerthanexpected.Thepresidentialproposals,mostofwhicharesupporting electronichealthrecordsalsoprovideaglimpseofthefuturetrendsinhealthcareinformation management. Theprimarybeneficiariesofelectronichealthrecordswillcertainlybepatientsandhealthcare organizations.However,otherconstituentssuchasinsurance,legalandfinancialentitieswill alsobenefitbecausewhentheswitchoveriscomplete,itwillmakeiteasierfortheseentitiesto sourcethemedicalrecordsoftheirclients.Theendbeneficiarieswillbethirdpartyoffshore outsourcingcompaniesdealinginmedicalrecordsretrievalandverificationservices.Benefitsto thesebusinessentitieswillaccrueintheformofincreasedworkorderswhenthetargeted switchovertoelectronicmedicalrecordsisfinallycomplete.

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July,2008