Many health care provider organizations are already on their way toward implementing electronic health records (EHRs). Few have achieved a completely paperless environment and many more are in a hybrid record state -- some components of the medical record are electronic discrete data and some are paper-based. Regardless of the path they take or the direction of their journey, CIOs have learned the "ABC's" of electronic record implementation. But how many know about the "D" -- document management?

The avalanche of paper documents produced from electronic clinical systems has caught many CIOs off-guard and underprepared. Furthermore, when patient information is entered, viewed and stored in a variety of systems, users cannot review the complete record in a single, central place. CIOs must find a way to bring all the information together, regardless of format or originating department.

Electronic document management systems (EDMS) solve these problems. They are a building block for EHR success and an important component to achieving a financial return. While an EDMS can serve multiple roles within a complete EHR strategy, the following are the most important:  

1)      Provide secure, long-term storage of information and output regardless of format or originating system.

2)      Give users a single, historical view of all patient information across systems.

3)      Create a legal medical record.

4)      Reduce costs and help deliver quantifiable financial returns.

Putting paper in its place

Many clinical components of the EHR are notorious for producing reams of paper output. Health information management (HIM) departments often experience doubling and tripling of medical record size and subsequent costs for storage requirements following the implementation of clinical systems, particularly laboratory and nursing documentation applications. Because of this, it is important for CIOs to understand the impact that each EHR module has on the back end, in HIM.

One way CIOs can help is to ask clinical information system vendors about the final output of their applications. According to Doug Turner, MHSA, FHIMSS, FACHE, who is the CIO of Maury Regional Hospital in Columbia, Tenn., "Clinical systems can be a source of frustration for many HIM departments, which are tasked with maintaining a legal record and often end up swimming in paper."

Second, CIOs can complement clinical applications with an EDMS. The EDMS provides a simple solution for capturing and maintaining large volumes of EHR output. Whether the output is paper, electronic data or images, an EDMS can receive output and automatically "file" information in the right patient record and in the right location using computer output to laser disk (COLD), or enterprise report management (ERM).

Centralized view of information

From the clinicians' perspective, trying to pull together the complete story of a patient by accessing multiple applications or different modules within an EHR simply doesn't work. Similarly, coders and other chart reviewers are less productive and accurate when bits and pieces of information must be gathered across two, three or four different systems. A centralized place for users to view the complete patient story is essential. An EDMS provides this place.

For example, emergency department physicians who need to access prior medical records like the ease and convenience of an EDMS -- even without the implementation of an ED documentation system. Traci Waugh, RHIA, director of health information and compliance at North Valley Hospital in Whitefish, Mont., repeatedly hears from ER physicians that the speedy retrieval of old records (specifically previous EKGs) from the organization's HealthPort EMDS is more than just convenient; it has helped saved lives.