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The Role Document Management Will Play in EHRs



Early this year, The Cleveland Clinic started capturing images of electrocardiograms in its document imaging and management system’s data repository and making the images available to clinicians via the clinic’s electronic health records system.

The MUSEC cardiology information system from GE Healthcare, Waukesha, Wis., produces a PDF file of the EKG images, saves it in the OnBase document management system from Westlake, Ohio-based Hyland Software Inc., and displays it through the EHR of Epic Systems Corp., Madison, Wis. The EKG’s order in the Epic records software includes a hypertext link to the PDF file.

“Not only does the PDF show up in the link to the order, but also in physicians’ in-baskets, so they don’t have to go looking for it,” says Dan Slates, director of integrated enterprise applications at The Cleveland Clinic.

The clinic this year also started capturing clinical retina images, storing them in the OnBase repository and making them accessible via the EHR. “The end user doesn’t really know they’ve left Epic to view the images,” Slates notes. “That’s nice because it doesn’t take them out of their EHR experience.”

Document management technology may seem somewhat old-fashioned compared with sophisticated electronic health records systems. But the well-established technology has brought some degree of clinical automation to many provider organizations long before EHRs. Users are finding the technology can substantially augment the capabilities of an EHR by digitizing paper documents and other data so that they can be stored in a data repository accessible via the EHR. Because of easier integration, some providers also use a repository to store electronic data from patient monitors and other devices, also viewable from the EHR.

For some users, such as The Bone & Joint Clinic in Franklin, Tenn., the document management system is the EHR. And it’s going to stay that way for some time, says Lisa Raines, CEO.

“We’ve not seen any products that we like better,” she contends. “Unless some brand new product comes along, I see no reason to change what we’re doing.” And document management backers don’t expect the technology to become obsolete anytime soon.

“We’d love to be paperless, but the reality is we’ll never be 100% electronic,” says Jenny Clyatt, administrative director of health informatics and technology at Proctor Hospital, Peoria, Ill. “Patients will come in with paper documents from elsewhere.”

The Missing Piece

Implementing document management software last October “was the last piece of the puzzle to make our electronic record whole,” says Michael Putkovich, a director of health information management at Spectrum Health Hospitals in Grand Rapids, Mich.

An intelligent document classification application from Irvine, Calif.-based Kofax Inc. is used with a document imaging system from Kansas City, Mo.-based Cerner Corp., as well as the vendor’s Millennium clinical information system used at Butterworth, Blodgett and DeVos Children’s Hospitals and related ambulatory surgery centers.

Kofax’s document classification application uses optical character recognition technology, enabling the vendor to program the system to recognize documents that do not have a bar code. All forms, including bar coded ones, also have a form title as a second level of classification.

Consequently, all scanned documents or inputted data are automatically filed in certain “buckets,” or event set codes.

Before Spectrum Health adopted document imaging, it had 1,400 paper forms. Those forms and the discrete data now are organized in 70 buckets.

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