Electronic Document Management System (EDMS): A stepping stone to implementing EMR in hospitals

Electronic Medical Record, commonly called the EMR is a software application that manages patient medical information created within a Care Delivery Organization or CDO. It contains the patient’s clinical information and data repository, clinical decision support databases, workflow manager, controlled medical vocabulary, orders manager, pharmacy and clinical documentation tools. An EMR is used by health practitioners to document, monitor and manage healthcare delivery within a CDO like hospital, nursing home or clinic setup. Although the healthcare industry is under pressure to move beyond paper and towards EMR and EHR (Electronic Health Records), the EMR adoption rate still remains low amongst most care givers.

During EMR implementation, usually a cut-off-date is established. Prior to this date, medical data shall remain on paper as is and after this date, the CDO shall move to the paperless EMR system. Sometimes, CDO’s continue paper based medical documentation parallel with EMR implementation. Even after EMR systems are implemented, care givers prefer to have selected medical information to be recorded on paper besides being electronically documented. Depending on the degree of automation being offered by the practice management software (PMS) or hospital information software (HIS), some medical information may be only recorded on paper due to lack of or delay in automation of the respective process or department.  Significant amount of medical documentation also gets generated from the patient’s clinical encounters with care givers outside the present CDO. Hence, a considerable amount of legacy data gets generated within and outside a CDO.

The question now arises that when we implement EMR and EHR solutions, what happens to the large amount of legacy data already existing in different formats?

The externally generated information may be received in the form of papers or as electronic documents and must also be incorporated as a part of the EMR. For follow up patients, the paper documents related to recent encounters can be scanned and linked to the electronic documentation in the EMR. Hence, it becomes essential to be able to process pre-existing electronic documents and paper records and link them to the CDOs EMR to be able to extract information to enable research and retrieval later. Whether or not to perform scanning depends on the amount of this legacy data present. Usually, only select information from paper documents is entered into electronic records. In this case, we would still require the paper documents almost indefinitely, at least for active patients.

Papers are commonly moved to an offsite storage location and/or scanned into a Healthcare Document Management System. Storage has a storage cost attached to it and in long term, keeping paper for life of a patient for an average 3-5 years retention period is expensive and has other pitfalls. Scanning all the documents can be cost effective over paper storage. Document Management Systems help in processing and storing both internally and externally created patient records in an electronic format, while facilitating authorized and secure access by users from multiple locations. Data hence extracted can be exported to EMR & eventually to EHR after definition of appropriate data set and making the scanned data more structured. A Healthcare Document Management System will help in creating an electronic record for both archived and active patient records and makes the transition to EMR and eventually EHR systems easy.

A good Healthcare Document Management System must have a configurable data repository structure and comprehensive security and access controls. Sometimes, Document Imaging is confused with Document Management System. While Document Imaging is the process of creating an electronic image from a paper document using a scanner, a best-of-class Document Management System not only helps in data capture but also encompasses workflows, data storage, data retrieval, electronic distribution, security and user defined linkage with HIS, EMR and EHR.

Once a document is scanned, Data Capture Process extracts specific pieces of information that facilitates subsequent search and retrieval by full-text Optical Character Recognition (OCR) and by populating index fields with specific metadata. A best in class Document Management System will have capabilities like zone OCR, pattern recognition, bar code recognition and database look-ups.

Workflow Manager feature in a Document Management System will perform electronic paper pushing and move, copy and delete document based on pre-defined user rules. It will also create work lists, email notification and timed alerts.

In terms of Data Storage, the Document Management System allows storage of converted records. Distributed capture of data and concurrent access of data by multiple users across multiple locations is supported. We should select a system with preferably an open architecture, standard database platforms and an n-tier architecture.

A good Document Management System has useful Search Capabilities like folder structure navigation, full-text search, metadata searches and searches based on record properties. Standard functionalities like fuzzy logic, wildcards, boolean operators, proximity searches and searches that combine these criteria are available. A search result interface helps in previewing lines of context with highlighted search items on the document. It would be ideal to have secure web access of documents on the web.

Data Distribution features like printing, faxing & e-mailing are standard to any Document Management System but should have security provisions and permit copying records, files, volumes and repositories to external storage on CD, DVD, flash drives etc. Disaster management and data recovery plan should be available and incorporated without fail. Remote access of data server should be possible.

In terms of Security, the Document Management System must protect patient information and other sensitive records on multiple levels by having provision of configurable user rights and privileges. Network security must parallel system security and should comply with HIPAA and other regulatory standards and laws of the land.

The New York State Archives has compiled a list of EDMS vendors in United States. This inventory lists organizations, their contact information, as well as a brief summary of services offered and is available in the following link:

http://www.archives.nysed.gov/a/records/mr_cons_edms.shtml

Few  EDMS vendors and their products have been listed from this source :

Company Product Name(s)
EMC, Inc. EMC Documentum Records Manager 6.5 (SP3)
Laserfiche Laserfiche Records Management Edition
Open Text, Inc. Vignette Record Manager v8.0
Alfresco Software Alfresco Records Management Module 3.2
Autonomy Corporation, PLC Autonomy IDOL: iManage RecordsManager v6.0
Autonomy Corporation, PLC Autonomy IDOL Records Management with MIP 5.2
Autonomy Corporation, PLC Autonomy ControlPoint for SharePoint
Hewlett-Packard Development Company LC HP TRIM Version 7
Iron Mountain, Inc. Accutrac, Build 43
Open Text, Inc. Open Text Records Management 4.2 (formerly known as Livelink ECM – Records Management)
Open Text, Inc. Open Text Records Management 4.2 with eDOCS DM 5.2.1
Hyland Software, Inc OnBase Certified Records Management
CA, Inc. CA Records Manager r12.6 with Microsoft Office SharePoint Server 2007 
CA, Inc. CA Records Manager r12.6
IBM, Inc. IBM Records Manager v8.5
Oracle USA Oracle Universal Records Management 11g
Open Text, Inc. Open Text Extended ECM for SAP Solutions 9.7.1
Open Text, Inc. Open Text Content Lifecycle Management Services for MS SharePoint 10.1
Systemware, Inc. Systemware Records Manager 1.1.0
IBM Corporation IBM InfoSphere Enterprise Records 4.5.x
  (formerly known as IBM FileNet Records Manager v4.5.0)
CA, Inc. CA Records Manager r12 with EMC Documentum v5.2
CA, Inc. CA Records Manager r12 with Microsoft Office SharePoint Server 2007
CA, Inc. CA Records Manager r12 with eDOCS DM v5.2
Feith Systems and Software, Inc. Feith Document Database 8
CA, Inc. CA Records Manager r12

Kindly contact the vendors directly for further enquiries.

 Authored by – Ms. Ranjeeta Basra Korgaonkar, Assistant Professor, International Institute of Health Management Research, New Delhi, India