It’s a Hybrid World                            Part 1

Managing Charts that Include Both Paper & Electronic Documents

While all eyes are focused on the exciting vision of the Electronic Medical Record and its impact on health care, for most facilities the real world is a bit less… glamorous. Many facilities live with hybrid medical records, and they anticipate living with a blend of paper and electronic records for some time.

Meta Health Technology recently partnered with AHIMA to sponsor a member survey in October 2009 on the subject of the hybrid medical record. The goal was to learn more about how facilities are managing the challenges related to the hybrid environment, and to share useful insights with the rest of the membership. Here are highlights of what we found to be the most interesting of the survey results, and some assessments from our work with clients that may help other facilities manage their hybrid records more efficiently.

It’s a Hybrid World

Nearly 80% of the facilities in the survey are maintaining hybrid medical records (figure 1). More than half of the respondents said that 50% to 75% of their records were on paper. While some facilities (14%) expect to achieve a totally electronic medical record within the next 12 months, 72% of them won’t be fully electronic for at least 18 months (figure 2).

Clearly, the fact that so many facilities have and will continue to have some records on paper compels an innovative approach to handling hardcopy records. This mirrors the experience of our clients, who have adopted a variety of technologies to streamline their processes in a hybrid environment. For example, many have implemented an electronic signature system with scanning capability to enable their physicians to easily sign both electronic and hardcopy documents. As additional documents are subsequently transitioned from paper to electronic format, simple system interface changes can be made to accommodate the electronic physician signature.

Success with e-Signature

In the survey, 81% of the respondents reported that their facilities are capturing signatures electronically (figure 3). While they report that a significant percentage of their physicians are now using their digital signature system, for some, physician resistance had been an obstacle in achieving widespread adoption and usage.

Obtaining physician compliance is often a challenge for HIM professionals, particularly when it comes to record completion requirements. We have found that clients achieve the greatest success in implementing an electronic signature and completion program when they focus their initial effort on a pilot group of physicians. This not only allows the facility to resolve any complexities that arise before a full blown “go-live”, but also provides them an opportunity to identify a physician champion who can assist in advocating for the new product or application. Additionally, communicating the quantitative results of implementation successes to key physician stakeholders, utilizing a facility newsletter or other vehicle, is an effective strategy for encouraging further physician adoption.

Benefits in Automating Deficiency Management

Automation of the deficiency management process can be a highly effective way for facilities to streamline HIM operations, particularly when they utilize a system that can automatically identify documents needing analysis. In the survey, 54% of the respondents said their facilities have automated the process, and 65% of that group said their system could automatically identify documents needing analysis (figure 4).

Deficiency management is often the bane of an HIM department’s existence, as the success of that process drives the department’s ability to provide complete information for continuity of patient care, reimbursement, quality reporting, research, and a multitude of other health care activities. For that reason, it is essential for facilities to put in place an efficient and effective record completion cycle, all the way from the analysis process through to physician signature. We’ve found that clients who automated the chart completion process not only reduced their completion costs by as much as 60%, they also saw measurable improvements in physician satisfaction. See Part 2…