I want to start by thanking everyone who stopped by the Extract booth at OHIMA24! It was a terrific event with a mixture of seasoned HIM folks, students, and a plethora of great exhibitors. Thanks to the OHIMA team for running such a great event.
One thing I can say for certain is that the health information of the patients in Ohio is in good hands.
The innovation happening in HIM was obvious. HIM is no different than any other field and is seeing an explosion of AI-based technologies.
But with all the buzz around these new technologies, the conversation that I had the most was, “Why is there still paper in healthcare?” Now, paper in this context doesn’t refer to just hard-copy paper documents. We are talking about paper, eFaxed, scanned, and emailed documents.
It is 2024 and most people outside of healthcare imagine that everything is digital, and their information is easily passed between heath systems — but that is not the case.
There is still a huge amount of “paper” documents that are notoriously manual to deal with as they are often unstructured. They are more like an image than a document, and they can’t be searched, copied and pasted from, or easily dealt with by HIM teams.
OHIMA Participant Polls
I ran a poll at the OHIMA conference this year and asked the attendees “What percent of your documents are interfaced with your EMR?”
The results may surprise you:
Some of the results were expected. The highest vote-getter was that 75% of their documents are interfaced and that is something we hear often.
But what was surprising was that nine respondents had 50% or less of their documents interfaced. Some of the people I talked with had no documents interfaced.
This means that these HIM teams are manually sorting and classifying documents as they come in before indexing the document to the correct patient record in the EMR.
If an HIM team received 10,000 documents a year, that wouldn’t be too much extra work. With 75% of documents interfaced, that would mean they have to deal with 2,500 manually each year.
How many documents are HIM teams actually seeing each year?
Millions.
This made me wonder… “What document types are the most manual for HIM teams to deal with”? I figured, why not do another poll for the OHIMA attendees.
Here are the results:
Release of information (ROI) requests and medical records were by far the most common answer to this poll.
You may be asking yourself why medical records are being faxed/emailed between organizations so often. It is best to explain this with an example.
Let’s say we have a person named Bill who lives in Minocqua, WI. Minocqua is a tiny town in northern Wisconsin. Bill loves being away from the big cities and out in nature.
He has a primary care provider (PCP) in town that he sees most of the time. But Bill also has some serious conditions that force him to travel to UW Health in Madison to see a specialist. Each time Bill goes between doctors those results need to be faxed back and forth between Bill’s PCP and UW Health. This can be a lot of faxes.
Bill also hates Wisconsin winters. In the winter months, he travels to Florida, where he has a doctor, he sees to monitor his health. Now these medical records need to be shared between the Florida doctor, his PCP in Minocqua, and UW Health.
You are starting to get the picture. It is easy to accumulate a lot of faxes between healthcare organizations.
But what about the ROI Requests? Well, here is where most of these come from:
Hospital
Patient
Attorney
Insurance Company
Medical research institute
Often these come via fax or email. Once the HIM teams get the request, they have to route it to the correct workflow and then retrieve the documents.
Again, a very manual process.
So, what can be done about these manual processes?
“Paper” Document Solutions
The three solutions:
Create interfaces for all of your document sources
Outsource the work
OCR-based solution
Each solution is best in certain situations.
Interfaces
Interfaces are a direct exchange of information between two systems. They are extremely accurate, fast, and allow discrete data to flow between two systems seamlessly. I’m sure you are thinking — “That sounds great, let's set up interfaces for everything”.
Well, let’s slow down just a bit.
Interfaces are very costly to stand up and require a lot of IT support. They also have to be configured for each document type and with each source the information is coming from. That means you would need an interface with each hospital, lab, etc.
You can see how these costs would pile up quickly.
Interfaces are best for document types with the highest volume and that come from a single source.
Outsourcing
Outsourcing can be a great option. It will boost an HIM team's accuracy and speed of getting information to the EMR. It is faster than manually processing but slower than an interface.
There are some downsides to outsourcing. First, it can completely demoralize a team and those around it since the lack of in-house document classification and indexing will result in layoffs.
You will also lose control of your organization's health information. You must trust an organization to keep your data secure, accurate, and get it into the EMR at the speed you agreed to. If there is a data breach, it will ultimately impact your patients.
This is a lot of trust to put into a third party.
OCR-Based Solution
Optical Character Recognition (OCR) broadly refers to technology that converts images and PDFs into text that can be used by a computer.
In healthcare, an OCR-based solution, like Extract, would automatically intercept your incoming documents, classify the documents, and extract all the relevant data. The document would then be quickly reviewed by a member of your team before being pushed to the EMR.
There are many benefits to this type of solution. It boosts the accuracy and speed of the data getting to the EMR. It is slower than an interface but faster than outsourced or manual.
You get to keep the data in-house. Most OCR-based software is set up onsite, meaning all the data is behind your firewall. Using your staff to verify captured information makes use of their institutional knowledge and familiarity with your documents while still multiplying productivity.
The downside of OCR-based solutions is minimal. The speed of data to the EMR would be a bit slower than an interface. There are also some implementation costs associated with training the software and interface work. But it is far less costly to set up than an interface.
While operational benefits are easy to talk about — the elephant in the room when talking about a software solution is the total cost.
Here is a figure showing how the cost of each solution changes as page volume increases:
As I said earlier, each solution is better than others in different situations. Manual processing is the best for very low page volumes, OCR-Based is best for medium to large page volumes, and interfaces are the best for very large page volumes.
Tying it all together
There’s still a lot of “paper” and electronic unstructured documents in healthcare. This isn’t ideal, but there are solutions out there.
Hospitals can be notoriously slow at implementing new solutions, so it is often up to HIM leadership to push these initiatives forward. Whether it is getting an interface or implementing an OCR solution is up to your team and your specific situation.
If you do want to explore the potential of an OCR-based solution, please reach out and I would be happy to talk about your specific situation in more detail.
I want to end this with congratulations to the three winners of Stanley Tumblers from Extract at OHIMA: Cassandra Mayne (Cleveland Clinic Rehab), Da’Ren Brooks (Cincinnati Children’s), and Bethany Hinton (WVU Camden Clark).
They were a big hit, and I will be bringing more to IHIMA24 next month. Hope to see you there!
About the Author: Ryan Fair
Ryan is a Regional Business Development Manager at Extract with experience in business development, consultative sales, project management, and product development. Ryan received his bachelor's degree in biology from the University of Iowa. As a partner for Extract's HIM clients, Ryan is dedicated to providing solutions that seamlessly integrate with current workflows and improve the quality of patient care.