This month we held the official "kick-off" meeting for our electronic document management system (EDMS) implementation. Our vendor spent several days onsite, met once again with all stakeholders and assigned homework. Our project launch and initial tasks exposed some very interesting things for us all!

Dear diary, now the real work begins. Our new EDMS partner (SDS, formerly Smart Document Solutions) spent several days on site to get our project started. They accomplished a lot during a short amount of time and laid the foundation for a successful implementation. Specifically, we completed the following:

-          Held communication meeting with all department managers

-          Spent significant time with first three departments to install

-          Gathered information about current workflows and processes

-          Began forms review and planning

Communications Meeting

Since many of the department managers had not been integrally involved with the evaluation or contracting process, they were not up-to-date with our decisions or implementation timeline. To remedy this situation, SDS held a high-level communications meeting for all managers within our facility. During this meeting, they re-introduced everyone to HealthPort®, overviewed the implementation process at a strategic level and discussed general timing for our transition from paper to electronic records. The meeting generated enthusiasm and support at all levels which will be integral to our success.  

The emergency department (ED) and the ED physicians were particularly happy to hear the news. They had been asked to postpone the use of new, manual documentation forms until scanning was available. With HealthPort, they had the green light to proceed. And because 24x7 access to ED records was one of the main drivers for our EDMS project, they were also selected as one of the first departments to "go live" with HealthPort.

The Key Three: HIM, Business Office and ED

Based on our organization's goals, the first three departments to implement HealthPort were identified as HIM, business office and the ED as mentioned above. To kick-off the project, we held in-depth meetings with all three. During these meetings, SDS repeated system demonstrations of HealthPort and conducted extensive interviews to better understand our current paper workflows and processes. While each department had policies and procedures, they had not clearly documented each step of information flow within - and between - departments. 

The in-depth meetings turned into an educational meshing of ideas. The dialogue within and between departments was enlightening. SDS was able to identify several areas where HealthPort's standard workflows could be adjusted to meet our needs. And our staff learned how current paper processes would be dramatically improved using the technology. Overall, it was a great experience for all three departments and strengthened our internal relationships. SDS did their part, now it was time for us to do ours!

Our Homework: Forms Review

After SDS completed their implementation kick-off meetings, homework was assigned. SDS asked all HIM and business office to collect all the various forms that were used and identify the following:

-          How do you want to index each form? To what level of detail?

-          How do you want each form to display?

-          Which documents do you share with other departments - how and why?

With regard to indexing hierarchy, we had several document types that could be indexed at a granular or general level. For example, we have a large number of consent forms at North Valley including surgical, transfusion, delivery and more. While each form has unique properties, we were asked to identify if they would be indexed at the specific (surgical consent) level or a higher, more general level (consents). The pros and cons of finite vs. high-level indexing were weighed for each form. And because none of our forms already had barcodes or a hierarchy scheme, we were able to start with a clean slate.

Secondly, SDS asked us to identify how we wanted documents to be displayed. For example, our ED charts are usually about five pages and much of the information is available through Meditech, except for EKG tracings. And of course, prior EKGs are the most commonly needed pieces of information for our ED physicians. We decided to set up our "view" of ED records at the patient and encounter level. Then within each encounter, only the EKGs would have a separate - or sub - folder for each patient. This decision made it easy to find prior EKGs and became a quick "win" with our ED physicians.

Lastly, SDS asked us to identify which documents were shared between HIM, business office and ED, when these documents were shared and why. This question helped us define workflows between departments and also identify areas of re-work that would be eliminated with the new system.

Lessons Learned

The most important lesson we learned during this month was that even small hospitals are plagued with maverick and unsightly forms. For us, the surgical department was the chief culprit. In fact, one of their forms had been photocopied so many times, it was barely legible!

Where forms are concerned, we learned that every department manager needs encouragement to improve. We worked to instill a sense of pride and ownership over forms and it really helped! Next month, we'll tackle forms education with the end user and begin the task of moving workflows from paper to HealthPort.

Traci Waugh is director of health information and compliance at North Valley Hospital, Whitefish, MT, and a client of SDS.