Digital Landfill

If all the politicians are saying it, it's got to be true!

I recently reread our State of the Industry survey, and a couple of points jumped out at me.  (Note: There's no charge to download; just registration.  Help yourself.)

Are these issues important to your organization?  Are these the things you wrestle with on a day to day basis?  How can we help?  (See AIIM Training)

From AIIM State of Industry survey (N=327)

#1: Organizations need help in creating an effective governance structure for their ECM initiatives.

• 24% - “No department has specific responsibility for managing electronic records in our organization.”
• 3 of top 4 obstacles encountered…

1. Underestimated process and org issues = 39%
2. Uneven usage due to poor procedures and lack of enforcement = 34%
3. Project derailed by internal politics = 30%

#2: Organizations are concerned about and need help in architecting how the pieces of an ECM architecture fit together.

• 42% currently integrating across departments.
• 40% working on an enterprise strategy.
• 33% = lack of training one of top 3 implementation obstacles
• Top 3 most desirable ECM attributes

1. Ease of use = 58%
2. Ease of integration = 46%
3. Ease of implementation = 41%

#3: Organizations have experienced the consequences of mismanaged information and need help/tools to manage this risk. 

• 34% would take more than a month to meet a basic e-discovery request.
• 40% of organizations answering have been exposed to legal or compliance risk due to poorly managed information.
• Many forms of basic business information are still largely unmanaged.

1. Emails = 57%
2. Email attachments = 63%
3. Instant messages = 80%
4. Office docs = 53%
5. Blog and wiki content = 78%
6. Text messages = 82%

#4: Organizations need better tools to quantify ECM benefits.

• Hard dollar justification very important = 32%
• 50% do not measure ROI

#5: Organizations need help figuring out what to do about SharePoint.

• 66% have implemented SharePoint or plan to.
• Only 17% have a formal plan in place to guide implementation of SharePoint and other ECM investments
• Current SharePoint implementations largely focused on low-hanging fruit.

1. 81% = for collaboration/workspaces
2. 65% = for basic document management
3. 50% = for fileshare replacement

• Disconnected from other core initiatives

1. 17% = no one in managing it.
2. 34% = IT managing with any RM input

#6: Organizations need help integrating their internal and external infrastructures; WCM still largely disconnected from ECM.

• WCM unmanaged for 20%; as a stand-alone app (relative to ECM) for 54%.

Management ECM Excuse #6: It’s easier to just get everyone together in person. If my staff needs to work together on a project, we find it more productive to send everybody a draft in advance and then have everyone fly in for a few days and sit together with all of the different versions and just hammer out the details. Plus everyone likes staying in hotels and having nice dinners.

Check out the video at http://www.aiim.org/excuse6.

Reality:

Sure they do! But since when is it your job to dole out working vacations? Plus, people’s schedules and workloads grow more taxing with each new economic report, so there’s really nothing “easy” about arranging for people to be in one place at one time – especially since doing so takes them away from their regular responsibilities and only makes their problems worse. And with airlines charging extra for everything from checked baggage to snack food, it’s hardly cost-effective to “have everybody fly in” anyway.

Electronic document technology makes it as easy to leverage talent around the globe as around the company, all without disrupting your workforce. Thanks to collaborative authoring tools, new delivery channels (Web, email, texting, etc,), and online meeting places (e.g., social networks, Webinars), people can work effectively together to create, access, and discuss materials of all kinds – without being derailed by the logistics of travel or the asynchronicity of time zones.

Getting everybody together at the same place and time quickly is becoming as quaint a notion as meeting for afternoon tea. It can be done, but in these hurried times may require more effort than it is worth. So why not avail yourself of the more efficient alternatives?

For more information:

AIIM training – http://www.aiim.org/training

AIIM research – http://www.aiim.org/research

Check out the video at http://www.aiim.org/excuse6.

Here’s my Baker’s Dozen of favorite Infonomics articles -- Click HERE to subscribe (it's FREE).

1. Is Your Company Clueless? A 10-Point Checklist
2. Are Open Source Web Content Management Systems a bargain?
3. Creating a Roadmap to SharePoint Success
4. Barack Obama: How Content Management and Web 2.0 Helped Win the White House
5. Shotgun Wedding or True Romance?
6. Are You Ready To Be Inspired?
7. "Going Green" while Converting to Electronic Medical Records at Swedish Medical Center in Seattle
8. Software as a Service Meets Enterprise Content Management, Take II
9. Four who Get IT
10. Scared of Change?
11. The Doculabs Quick Guide to SharePoint Governance and Adoption Planning
12. Got the Picture? Securely? - Five Approaches for Distributing Imaging Services
13. Better Luck Next Year 

Click HERE to subscribe to Infonomics.

We thought we give the social networking community a bit of a preview of our new E20 survey.

I came across an interesting paper from last year from an AHIMA group that did a good job of discussing the intersection between electronic health records and overall records and document management.  The paper is entitled Enterprise Content and Records Management for Healthcare.  

What I particularly liked about the paper is the graphic on the left, because it illustrates for me the challenge that we are likely to face as the process of certifying electronic health records providers proceeds as part of the Obama Administration stimulus project.  

(See previous post, What I Know So Far About EHR and EMR and ECM)

I think a key issue here for document solution providers is how the certification process will work across the concentric circles in the diagram.  The EHR provider certification process likely to be conducted by CCHIT will likely be focused on the inside two circles.  Given the decentralized and balkanized current nature of healthcare automation, many document management solutions currently play in the outer ring.  

So my question -- the same one I raised in my earlier post -- is how the product certification process will manage the connection points between the three rings -- and especially the outer ring.  My fear -- and I'd welcome comments on whether this is unfounded or not -- is that many "document management" solutions may be crowded out by the stimulus money or not even on the table because the solutions are not on the certification list.

Is my fear misplaced?

We have a group on InformationZen for those interested in this issue.  All are welcome -- just sign up on Zen and request admission to the group.

I did a fun interview with Kevin Craine recently during his podcast series.  You can access it by going directly HERE or by navigating the widget below.  I'm on podcast 9.

Management ECM Excuse #5: It’s good for staff to be busy. We understand that professionals can spend an average of 1 1/2 hours per day processing emails. That’s what we pay them for.

Check out the video at http://www.aiim.org/excuse5.

Reality:

No it isn’t. You pay them to make good decisions in a timely fashion. You pay them to come up with new ideas for moving the business forward. You pay them to be the public face of your organization. If you don’t think you do, then you’re in the wrong business – or more likely, out of business altogether.

Having said that, let’s be clear that there’s nothing wrong with keeping people busy – in fact, most people want to be kept busy, or their days drag and they begin to look for new employment. But what they really want is to be productively busy: intellectually challenged, fully engaged in what they’re doing, and working toward some tangible end. Having them chase information on a regular basis achieves none of these objectives – especially when they know there are technologies available that can do much of this work for them.

Strange as it sounds, information management thus can be considered an employee retention tool of sorts: the kind of enabler people can grab onto to rid themselves of their more mundane tasks in order to tackle more productive, fulfilling work. Then watch how busy they become!

For more information:

AIIM training – http://www.aiim.org/training

AIIM research – http://www.aiim.org/research

Check out the video at http://www.aiim.org/excuse5.

Here are some of the things that I think I have figured out about document management solutions and electronic health records and the stimulus program.  I send them around not so much under the thought that they are 100% correct, but rather to make get some correction and additions from the collected community.

To get involved in the discussion, join our Electronic Health Records Forum.

Here are the steps you'll need to follow once you get there...

Here are the 3 steps to follow:

1. If you are not currently a Zen member you will be asked to create an account. 
2. Once you do so, you will see a form to request admission to the Electronic Health Records Forum.
3. You’ll then get a follow-up email activating your request.

So here goes…

There is $23 billion in play in two portions. 

One portion ($2 billion) goes immediately to HHS and its sub-agency, the Office of the National Coordinator for Health IT (ONC) and directs creation of standards and policy committees.  We (AIIM) are actively working to connect our PDF/H work up with the efforts being directed by the ONC.

The second portion sets aside $21 billion (net) to physicians and hospitals to implement electronic health records.  There is a program designed for those who see large volumes of Medicaid patients, and another for those that accept Medicare.

In order for physicians and hospitals to qualify for the incentive payments (that will begin in 2011), they must demonstrate 3 things:

1. Use of a certified EHR product with ePrescribing capabilities that meets current HHS standards.
2. Connectivity to other providers to improve access to the full view of a patient’s history.
3. Ability to report on use of the technology to HHS.

So obviously a central question related to number 1 is who is doing this certification and how does it affect the business of our members?

The legislation does not mandate a specific certifier.  Most seem to agree that CCHIT (the Certification Commission for Healthcare  Information Technology) will wind up being the certifying organization for acceptable EHR solutions relative to the stimulus funding. 

CCHIT is a private nonprofit organization with the sole public mission of accelerating the adoption of robust, interoperable health information technology by creating a credible, efficient certification process.  The Commission operates with a nine-member volunteer board of Trustees, 21 volunteer Commissioners who represent all sectors of health IT and provide strategic guidance and oversight for the certification process and criteria, and 170 volunteers who serve on 15 workgroups and bring their expertise to the process of creating the certification criteria. 

Last week, CCHIT announced that it has approved final 2009-2010 criteria for certification of Ambulatory (office-based), Inpatient (hospital-based), and Emergency Department electronic health records (EHR), and for its newly developed stand-alone Electronic Prescribing certification. The Commission also approved updated criteria for the Ambulatory add-on options in Child Health and Cardiovascular Medicine. Besides the detailed criteria and test scripts, the Commission will publish a companion guide mapping the criteria to the characteristics of a qualified EHR as described in the American Recovery and Reinvestment Act (ARRA). The materials will be published on May 29 at www.cchit.org.

Speculation seems to be that CCHIT will then become the certifying body and the criteria the framework for determining which solutions will be approved and which will not for stimulus funding.

I am guessing that the criteria will be similar to the existing criteria, which can be summarized as follows:

• Organizing patient data – demographics, clinical documentation and notes, medical history
• Compiling lists – problems, medication, allergies, adverse reactions
• Receiving information – test results, consents, authorizations, clinical documents from outside the practice
• Creating orders – ordering medication or diagnostic tests; managing order sets, orders, referrals; generating and recording patient-specific instructions
• Supporting decisions – presenting alerts and reminders for disease management, preventive services, wellness; checking for drug interactions and guiding appropriate responses; supporting standard care plans, guidelines and protocols; updating decision support guidelines
• Authorized sharing – managing practitioner/patient relations, enforcing confidentiality, enabling concurrent use among multiple practitioners and healthcare personnel
• Managing workflow – assigning and routing clinical tasks, managing the taking of medication and immunizations, communicating with a pharmacy
• Administrative and billing support – using rules to assist with financial and administrative coding; verifying eligibility and determining insurance coverage

So it would seem that the questions before us are something like the following:

1. How will CCHIT as the certifying body and some version of the above criteria effect business opportunities for our typical document management solution providers? 
2. How will the crowding out impact that $20 billion in funding on “certified” healthcare IT spending have on existing spending?

For example, here are the kinds of health applications in which many of our companies engage.  How will the presence of the above effect these applications?

• Conversion of medical records from paper to electronic
• Offsite storage of medical records
• Chart Deficiency Management
• Release of Information
• Linkages between existing document management solutions and certified EHR solutions
• Patient financial services/EOBs
• Common back office administrative functions

So what do people think?  What’s right?  What’s wrong?  What should we be worried about?