A little over a year ago, Deaconess Health System in Evansville, Ind., obtained a lofty perch on the digital health I.T. rung-the six-hospital system was named as a HIMSS Stage 7 organization, representing the pinnacle of electronic health record accomplishments. And indeed Deaconess is highly automated, running an Epic suite across both its inpatient and ambulatory areas. Epic even stands as the hospital's "legal record," or its official repository in case of lawsuits. It wasn't always that way though.

Prior to 2009, Deaconess's document management system, Hyland Software's OnBase, which houses scanned images of paper records, served as the official record. Despite its demotion, the OnBase system is not going away anytime soon. "You'd think you would scan less as you move up the HIMSS ladder," says Pam Smith, application analysts. "But we're still scanning a lot."

On the inpatient side, the volume of scanning has diminished, she says, noting that physician orders, nursing notes and the medication administration records are now electronic, supplanting the need to scan and store their paper forebears. Yet, on the ambulatory side, it's another story, says Smith. "Ambulatory scanning has stayed the same because of all the information coming from outside locations." In addition to drivers' licenses and insurance cards, ambulatory settings must also scan in lab results coming from other locations, consent forms, and a potpourri of other documentation toted in by patients, such as insurance letters. "I am surprised at how much scanning remains," she says.

Smith's bemusement is widespread. Even as they push to increase the scope and depth of indigenous electronic data, many health systems find that they are dealing with a flood of paper documentation. Historical records from acquired group practices can form a big chunk of the work. And even among the highly automated, the vast number of systems in play may all but demand using document management technology as the centerpiece of a data repository, if not the legal record. Yet, to make the most out of document systems can be challenging-the technology itself, often bar code-enabled, is fairly robust. However, managing the workflows and data feeds needed to sustain it can be daunting. That's why some have turned to outsourced third parties to handle the work. Do the technology right, experts say, and document management systems can offer benefits well beyond just retiring expensive paper chart storage.

Gary Baldwin’s feature story in the April issue of Health Data Management examines the continued importance of document imaging and management to improve documentation and workflow even in an era of increasing automaton of health information.

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