Integrating Third Party Document Management with EpicCare

1. Integrating Third Party Document Management with EpicCare April 7, 2006 Ranelle Bauer – Allina Hospitals & Clinics Allina’s Electronic Medical Record System

2. Agenda • Definitions • Integrated Scanning Group • Build Discovery • Decentralized Scanning vs. Centralized Scanning • Buffalo Hospital • Abbott Northwestern Hospital • Ambulatory vs. Hospital Scanning • Training • Scanning Workflows • Scanning Matrix • Relationships between EDMS team and Excellian Team (Ownership) • Versioning Challenges • Deleting Scans • Questions Allina’s Electronic Medical Record System

3. Epic Products Being Implemented • Identity • Cadence - Hospital & Ambulatory • Prelude • Prelude ADT • Health Information Management • EpicCare Ambulatory • Radiant • Resolute - Hospital & Ambulatory Settings • Optime • EpicCare Inpatient - Clin Doc/Orders/CPOE/ED • EpicRx Inpatient Pharmacy • MyChart/Epic Web Allina’s Electronic Medical Record System

4. Definitions • Excellian – Allina’s term for Epic. • EDMS – Enterprise Document Management System • OnBase – Third Party Scanning Vendor • Centralized – Health Information departments having most ownership of scanning. • Decentralized – Health Information departments working in conjunction with point of care areas to complete scanning in a timely manner. Allina’s Electronic Medical Record System

5. Definitions • Patient Level Scans – Are documents that “live” across all patient encounters and visits. Examples of these would be legal documents and health care directives. • Encounter Level Scans – Are documents that are scanned and live at the encounter level. They can be viewed at the encounter the scan is associated with. An example would be an informed surgical consent or an anesthesia record. • Order Level Scans - Are documents that are scanned and live at the order level. They are usually results that update the order. An example is EKG or ultrasound report. Allina’s Electronic Medical Record System

6. Integrated Scanning Group • Silo’s – Every team was working within their own applications. Teams started to do their own thing regarding scanning. • We found the need to come together and make scanning integrated. • Excellian HIM became sole “owner’s” and facilitators of all scanning needs. • We formed an Integrated Scanning Group to make all decisions needed. Allina’s Electronic Medical Record System

7. Integrated Scanning Group Cont. Developed a scanning strategy packet for sites to use to help facilitate their own integrated scanning groups. • Things To Think About: • Forms Inventory. You need to start thinking about the forms you currently have. How many forms will stay on paper? • Communication of label placement. • Document Type Names. Do you have new document types to add to the current list provided. If so, please use the Scanning Document Name Add/Change Form. • Decisions To Be Made: • Who is taking responsibility for the majority of scanning? • How much point of care scanning will be taking place? • Who will be doing the order level scanning? • Who is responsible for scanning EKG’s? Allina’s Electronic Medical Record System

8. Integrated Scanning Group Cont. • The group consisted staff from HIM, ADT, Cadence, ClinDoc, OpTime, Radiant, Orders, Interfaces, EpicCare Ambulatory, Prelude and EDMS team. • The group decides the document types and workflows. • Examples of agenda items are: • Approve new document types. • Design new fixes regarding scanning. • Help facilitate training needs. • Develop new ideas to improve scanning. Allina’s Electronic Medical Record System

9. Build Discovery • Our first challenge with our scanning strategy was to do the build discovery. We have found may different “places and tables” that build had to occur in order to integrate with OnBase. Here is what we found: • DSC 100 Build – We use this table for any patient level scans. We have also built most order level scans for the hyperlinks to display the correct document type. • LPR 1830 Build – This table is built for our document types drop down menus. • EPT 19104 Build – This table is built for interface tables. • OnBase Build – This is build for batch scanning with in OnBase. • Interface Build – There are two tables that need the documents types added to be able to accept documents through the interface. • Security Build – Shared security needs to have document types added for the ability to create patient level scans. Allina’s Electronic Medical Record System

10. Centralized Vs. Decentralized • Buffalo Hospital’s Approach • Buffalo Hospital’s original approach was to be decentralized. The thought was to reduce the number of FTE’s for HIM. • We found challenges right away a go-live. Some of the challenges were: • Lack of importance form other areas. • Scans were distorted. • Timeliness of scanning was insignificant. • Lack of proper training. • Many indexing mistakes. • Untimely scanning. • Buffalo now has a more centralized approach. Found to be more timely and accurate. • One year after go-live paper documentation has decreased extremely. Allina’s Electronic Medical Record System

11. Centralized Vs. Decentralized Cont. • Abbott Northwestern Hospital’s Approach • Abbott Hospital’s started and continues with the centralized approach. • Abbott has two locations within the hospital that are doing their own batch scanning. HIM is indexing these documents. • Found to be successful but with some challenges. Here are few examples: • Abbott started cross training staff a month before go-live. • Unaware of the volumes of paper documentation and scanning needs. • Unaware of needs of Hospital Based Clinics • Didn’t anticipate the time it would take to do indexing. HIM got behind at Go-Live. BEEF UP SCANNING NEEDS! • Deployed scanning areas. Allina’s Electronic Medical Record System

12. Ambulatory vs. Hospital Scanning • Ambulatory Scanning Strategy • Ambulatory found the need in the beginning to have a different approach to scanning. • Started using EpicScan for all levels of scanning. • Currently Ambulatory is implementing OnBase for their batch scanning for encounter level scanning. They are now using documents list table for patient level also. • Creates historical orders to scan historical documents. This makes the ease of finding and comparing documents like EKG’s. • Hospital Scanning Strategy • Started with OnBase as scanning solution for batch scanning. • Registration scanning patient level documents. • Point of Care staff scanning order level scans. Allina’s Electronic Medical Record System

13. Training Challenges • We have had difficulties with coordinating and configuring scanners for “hands on” practice. • Lack of actual scanners for all training classes. • Lack of teams stressing the importance of indexing and quality of scanning. • Training materials didn’t stress the importance of timeliness of scanning documents into the system. Allina’s Electronic Medical Record System

14. Scanning Workflows Allina’s Electronic Medical Record System

15. Scanning Matrix Allina’s Electronic Medical Record System

16. Relationships Between EDMS Team and Excellian Team (Ownership) • EDMS team “owns” the OnBase Application. (This is an IS based team) • EDMS team builds and owns their own set of security within their application. • EDMS has their own support staff. • EDMS is considered part of the IS structure and not the Excellian structure. • Excellian HIM team “owns” the Excellian Application. (This is project based team) • HIM team builds document types in the DCS 100, LPR 1830, & EPT 19104. • IBT coordinates the security for scanning. • HIM coordinates the build with Interface team and EDMS team. • HIM is the coordinator for all of the Integrated Scanning Group meetings. • HIM team has their own support staff. • HIM has the relationship with Epic. Allina’s Electronic Medical Record System

17. Versioning Challenges • We are finding a need for versioning documents. • Currently we are scanning incomplete documents into Epic. After the document is complete, we are scanning in the completed document. We are then deleting the incomplete document. • A couple of solutions that were purposed lacked the ability to be more automated. • We are still in talks to come up with a solution. • We would like to be able to sign a scanned document to improve incomplete workflow. Allina’s Electronic Medical Record System

18. Scanning Workflows Cont. Allina’s Electronic Medical Record System

19. Deleting Scans Allina’s Electronic Medical Record System

20. Questions? Allina’s Electronic Medical Record System

21. Thank You! Contact Information Ranelle Bauer, RHIT Ranelle.Bauer@Allina.com 225 South 6th St, Suite 1000 Minneapolis, MN 55402 Phone 612-775-2392 Fax 612-775-2392 Allina’s Electronic Medical Record System