Download Knowledge, Image, and Consent Management

Filling Gaps in Your Epic Implementation
JUNE 2014
Midwest Informatics, LLC
Connecting the Docs
SM
Introduction
Epic makes wonderful software, but they are happy to tell you
that they don't do everything. If you only implement Epic,
there will be gaps in your implementation and your operations.
Talk to any Epic rep and they are happy to admit that: “we’re
not a (hardware or imaging or forms) company." Epic IS a
software company and they are a juggernaut in the electronic
health records (EHR) industry who has earned their place at
the front of the pack.
But if you want to fully automate your workflows and someday
be truly paperless, you will need a few other strategic partners
/ vendors. Depending on who you pick, the quality of your
patient information and your revenue opportunities are at risk.
This paper examines what Epic doesn't handle, or doesn't
handle well, and will help you determine the best vendors to
fill the gaps in your Epic implementation, so you can maximize
your quality of care and your revenue opportunities.
The 3 ‘Extras’ You will Need - Vendors to
help you with:
E-FORMS
DOCUMENT MANAGEMENT
E-SIGNATURES/CONSENTS
The product/capability gaps that Epic doesn't handle well (or at
all) can be categorized broadly as: e-Forms, Document
Management, and Consent Management. Hardware is also
something Epic doesn’t help you with, but that is not addressed
in this analysis. The 3 areas above, though, are problematic.
Epic doesn't handle eForms, Consent
Management, or
Document Management
(not well or not at all).
The e-Forms gap is easy to understand and
fairly easy to close with the right vendor.
Epic, like all EHRs, is essentially a medical
forms, expert system, and workflow engine.
Epic's database stores the patient information
captured during an encounter or hospital stay
in Epic’s patient database. Epic's internal
expert system, technically a Clinical Decision
Support System (CDSS), examines the information collected and
triggers an on-screen message if there is a patient safety issue,
e.g. a drug allergy. The CDSS will also make recommendation
based on Evidence-Based Medicine guideline, so the doctor is
always aware of the best-practice treatment for a given patient’s
diagnosis, history, and the medications currently being taken.
The gap in this process occurs when doctors have to use paper
forms and the patient’s data is not available to the CDSS,
reporting system, etc.
This is a fairly common situation. When you 'go live' with Epic,
you always have to make choices about which forms you build into
your system before you "go live" and which forms will remain on
paper. The theory is that for those less commonly used forms,
you can just fill out the paper form, scan it into Epic, and build it
into Epic when you have more time. In my experience, there will
always be something more pressing - a bug to fix, a new clinic or
department to get live, an upgrade, etc. So those less frequently
forms rarely, if ever, get built into Epic.
Epic resources are often
so stretched that many
forms are not built into
Epic – instead, the paper
form is scanned in later.
After making well over 100 hundred phone
calls to HIM Directors and after dozens of
conversations with Epic customers and Epic
experts, every organization faces this
problem. The common solution is to just use
the paper form and scan it into Epic later.
Everyone admits that this solution is a
problem in itself.
That’s better than not having the information in the system at all,
the logic goes, but if the form is filled out on paper and simply
scanned into Epic, there is the inherent risk of hand-writing
errors, lost documents, and forms scanned into wrong EMR
location.
For optimal patient care and for the sake of your bottom line, it
should be everyone's goal to unleash the full power of their EHR.
Which means you need discrete data. Organizations need to
constantly push for improved automation and move in that
direction whenever you can.
The table on the following page demonstrates the continuum of
automation with regard to medical forms, patient data collection,
and the end-state of each stage:
AUTOMATION COLLECTION
STAGE
METHOD
Pen & Paper Paper Form
with handwritten data
entries.
TRANSMISSION
METHOD
Scanned into
Epic (or
OnBase, then
Epic).
ENDSTATE
Automated &
Pen-Free
e-Form: pick
lists,
dropdowns,
keyboard
entry.
Imported into
Epic or
OnBase, then
Epic.
Directly
imported, no
data, no handwriting errors.
Automated &
Integrated
e-Form+: pick
lists,
dropdowns,
keyboard
entry.
Exported to
PDF or HL7.
Mapped &
imported into
patient
record.
Discrete data in
patient
electronic
record.
Scanned Image,
no data, handwriting errors.
Clearly, a step in the right direction would be to eliminate the handwriting and the errors that accompany it. The Automated & PenFree method entails collecting data on an e-Form, where the user
accesses the form online and completes it using drop-down lists and
enters data using a keyboard.
Third-party technology exists to capture data electronically and
eliminate scanning. e-Form solutions supplement the EMR and
improve the flow of patient information. The benefits to the hospital
are reducing human error and preventing delays in care by having
quicker access to archived documents.
The final stage, Automated & Integrated, would be to export the
data collected on the e-Form and upload it into the EHR.
e-Forms Vendors - at a glance
Most of the vendors listed in this market are actually EHRs
themselves, e.g. Epic, Cerner, McKesson, CPSI, and Medhost.
FormFast, the leading e-Forms vendor with approximately 15% of
the overall market, specializes in e-Forms products and has a full
suite of products and functionality.
RECOMMENDATION: FormFast ability to interface with Epic and
populate e-Forms with patient data, and their ability to capture
data on e-Forms through drop-down lists and checklists are the
most advanced in the market. From a vendor recommendation
standpoint, it is wise to select a vendor that you are sure will be
around for the next 5-10 years or more. FormFast has been in
business for over 20 years and is the market leader with hundreds
of e-Forms customers and the most mature product line. For
these reasons, FormFast is the best e-Forms vendor on the market
today.
Enterprise Content Management Vendors
Enterprise Content Management, once called document management
in simpler times, extends the simple capture and storage of
documents to managing digital data from almost any source and
storage of these pieces of content in hundreds of different formats.
This flexibility and ability to handle complex data allows ECM systems
to be the one-stop-shop in your enterprise for capturing,
transforming, and storing healthcare data, business forms, and
financial data.
Epic provides a very simple document and image capture tool called
the "Media Manager" which allows you to scan documents or capture
photos or other images and store them directly in the patient's
electronic record. If you need more than that, Epic will (again) be
happy to tell you that "we're not an imaging or document
management company". Along those lines, if you ask them "then who
is, who do you recommend?" they will tell you that they don't
recommend any 3rd party vendors, but they will be tell you who
"some of our other customers are using." Hyland's OnBase will appear
on that list 10 times more often than anyone else.
The reason, Epic will tell you, is that Hyland and Epic have been
working together for some time and have developed a tight
integration between OnBase and Epic. Having implemented OnBase
alongside of Epic on several occasions, I can personally attest to this
seamless integration. Users logged into Epic might never know if or
when they are actually using OnBase, which is great for healthcare
professionals who just want to get the job done as quickly and simply
as possible.
ECM Vendors - at a glance
Other than this integration with Epic, OnBase, as well as
Perceptive and other leading ECM vendors are fairly equivalent in
terms of scanning medical records or financial documents. But
OnBase also offers enough extra capabilities that make OnBase a
must-have in my view for any hospital or multispecialty
ambulatory practice.
An example of OnBase's value-add features and functionality in a
healthcare implementation is best exhibited by OnBase's "sweep"
capability, which allows you to gather patient files stored on
external systems, e.g. GE Muse Cardiology servers, and copy those
patient files (EKG results, strips, etc.) into the patient's Epic
record automatically. This feature is invaluable replacement for
building a custom HL7 interface between Epic and Muse, for
example, which saves you significant interface development time
and money.
RECOMMENDATION:
In the HIMSS Analytics database,
OnBase is the market leader for products that are not full-fledged EHRs
like McKesson, Cerner or Meditech. But, as mentioned, OnBase is the
dominant ECM being deployed alongside Epic. In our research, 80% of
Epic customers interviewed use Hyland's OnBase. If you are looking for
the best integration with Epic, OnBase's superior features make it the
best-of-breed in that space.
e-Signatures & Consent Management
HIMSS Analytics does not collect vendor data on the e-Signature or
Consent Capture/Management markets. The data from the research
group would indicate, however, that ~73% of these customers collect
e-signatures on paper and then send that paper to the HIM
department to be scanned into Epic (usually using OnBase for the
scanning). Only 6.7% have a custom form and method for capturing
signatures, and 20% use a combination of OnBase and Topaz signature
pads to capture physical signatures.
Epic can only capture
one (1) signature per
document - treating
minors requires patients
and parent signatures
Epic, natively, only supports 1 signature per
document, due to the way Epic stores
signatures as annotations.
Many consent
forms, however, require more than one
signature, e.g. for patients who are minors,
which requires a consent/signature from the
minor and a consent/signature from a parent
or guardian.
There are workarounds to the 1 signature limitation, but workarounds
require ongoing, manual labor which can be a costly and error-prone
themselves. This situation limits use of the Media Manager for
consent capture to a paper and pencil process where a paper consent
form is used and both signatures are hand-written and then the paper
consent form is sent to Medical Records/HIM for scanning. This is the
same process for OnBase or Media Manager scanning of paper
signature.
e-Signature Vendors - at a glance
A better way to capture physical signatures might be to use
FormFast's e-signature product with or without OnBase.
FormFast's products allow you to gather any number of consents
at the bedside or in the ER or anywhere else. FormFast typically
recommends use of signature pads at registration with a
secondary monitor to display their e-forms or a mobile tablet for
bedside consent. This combination allows maximum flexibility in
where it is used. FormFast's ability to customize e-forms, i.e.
consent forms, also allows for easy tailoring by the customer if
these forms change.
RECOMMENDATION:
FormFast e-signature products are
best known to their Meditech customers, which number in the hundreds,
or to their McKesson customers. But FormFast would work just as well
with Epic or other EHRs and the consent forms themselves are easily
modified with FormFast tools. For these reasons, FormFast e-signature
products are the recommended solution for consent capture and other esignature needs for Epic customers, as well as the Meditech, McKesson or
other EHR customers they serve today.
SUMMARY
Market leadership, history, and company stability are important considerations
in the volatile healthcare IT vendor market these days. It is also wise to look
for vendors with strengths in complementary areas so you can get the most
bang for your buck. FormFast's 20-year company history and stability make it a
safe bet. Hyland's OnBase is another product that provides a superior product
to their healthcare niche and whose product can also be used in financial /
business settings too. Epic is the clear leader in the EHR market and with
$1.8B in revenue last year, are in no danger of going out of business anytime
soon.
These factors taken together, the best mix of vendors to fully automate
healthcare delivery today is Epic for EHR, Hyland's OnBase for ECM, and
FormFast for consent capture/e-Signature and e-Form needs.
About Us
About Midwest Informatics (MI)
MI combines state-of-the-art informatics technologies and
Lean methods to deliver solutions healthcare providers can use
and advice you can trust. MI specializes in healthcare project
and
program
management,
research,
EHR/Epic
implementations,
strategic
planning,
organizational
development / organizational change consulting, health
information exchange, and making healthcare and your
organization more Agile and innovative.
About FormFast
FormFast is the leading provider of process automation
Solutions for hospitals. Our comprehensive set of technologies,
including eForms, eSignature, workflow, and ECM, integrate
with existing systems to add functionality and streamline slow,
outdated practices enterprise-wide. More than 1000 hospitals
around the world rely on FormFast to help them make the
transition from manual tasks to fully automated processes.
About Hyland
Onbase by Hyland is one of the most flexible and
comprehensive ECM products on the market today. OnBase
empowers users to grow their solutions as needs change and
business evolves.
It is tailored for departments, but
comprehensive for the enterprise, designed to give you what
you need today and evolve with you over time.
Midwest Informatics, LLC
tel : 636.484.0470
FormFast
tel : 800.218.3512
Hyland
tel : 888.495.2638
© 2014 Midwest Informatics, LLC