1 — Access to external documents

It’s 3 a.m. and you’re in the emergency room. But you can’t talk. Remember all of those records you brought with you last time you were at the hospital for outpatient surgery? Lab work, radiology report, physician notes…all in paper. Where did those records go? With an ECM integrated with the hospital’s Electronic Medical Record, your physician doesn’t just have the hospital’s notes from your previous visit, but all of that external documentation was scanned in and is now a click away in the EMR interface where the clinician can now see a more complete history prior to providing treatment.

2 — Access to medical records in the hospital

Unfortunately, after visiting the ER, you are admitted. Even in heavily automated hospitals, you will often find that Emergency Department charts are still kept on paper. However, that paper ED chart may not always ride with you to your room. Scanning that chart in to the hospital’s ECM system linked to the EMR allows any clinician with security rights to see your chart info in the EMR to access your info. So whether you end up on a regular floor, ICU, Radiology or Lab, you can rest in that morphine-induced happy place knowing that your caregivers can access all of your information since entering the hospital.

3 — Always on 

In today’s growing world of outpatient services, hospitals and their affiliates are often sharing chart info between facilities. The good news is that AnyTown Hospital may in fact be the keeper of all of your records because you go to AnyTown physicians, AnyTown Radiology and AnyTown Orthopedics. Unfortunately, as you arrive at the ER, your paper chart info hasn’t come back from AnyTown Outpatient Surgery Center, and your file is ‘out’. With ECM, your file never moves. No faxing. No couriers. One file – online. Available to all of AnyTown’s caregivers through their EMR interface.

4 — Diagnostic data

While healthcare providers are adopting scanning technologies in rapid numbers, they are only scratching the surface of ECM capabilities. Upper tier Content Management products are truly object repositories – not just electronic file cabinets for scanned paper. So content such as audio files and video files could be dictation recordings and surgery videos available through your ECM. Digital photos for things like wound care, dermatology or burn units can all be easily imported in to your ECM.  Forward thinking thought leaders are even beginning to leverage ECM as middleware. Diagnostic info, e.g., EKGs, Fetal Monitors, Holter monitors and more are not integrated with the EMR in most cases. Printed copies of Fetal Monitor strips are often taped to pages in a paper chart. Your history of EKG’s are printed off and kept in paper form and may not be available for reference as you enter the ER suffering from chest pain. With ECM, direct device integrations can be done to electronically receive, store and integrate this data for instant availability directly through the EMR interface.

5 — Patient safety

Clearly, greater availability of information at the physician’s fingertips could be the difference in critical care scenarios. Lawmakers offhandedly cite ‘medical errors’ as the premise for electronic medical records. The term though is in most cases a misnomer labeling physicians as having made errors. Unfortunately, in most cases their ‘error’ was in fact a lack of available information. While EMRs are a step in the right direction, most industry data states that at least 20% of the chart remains in paper form today, leaving physicians and patients alike in a precarious information deficit. With ECM, that paper is scanned and available, integrated through the EMR creating one holistic record.

6 — Privacy

A quick read of the HIPAA regulations are not only a great cure for insomnia, but magnify the vagaries of ‘private information’ in a paper world. While great care is taken in defining rules and regulations around the securing of electronic data, one would argue that the standards as they apply to paper records are a bit more challenging to enforce. Copies, faxes, couriers, outsourced paper storage providers all present potential challenges in enforcing secure access. A well designed ECM security model ensures that only authorized users access your documents; even printing can be controlled. In addition, an audit trail logging every user who accesses any document in your chart – and even any action they perform while viewing it – provides peace of mind that your Personal Health Information is secure.

7 — Release of Information

Whether it’s a move to a new city, a new physician or a new health insurer, you may need your records in portable form. While EMR’s can produce a report for you, paper charts – if immediately accessible may need to be copied, faxed from multiple locations, pulled from offsite storage, etc. Healthcare focused ECM products often contain the ability for the hospital to go through a simple ROI workflow to produce all of the scanned components of your chart along with your EMR report. In fact, some ECM/EMR integrations offer the ability to do that through the EMR as a singular process.

8 — Scalability and Integration 

A number of EMR’s offer document imaging as native functionality. However, scan and store capabilities within an EMR should not be confused with the breadth of functionality a true Enterprise Content Management system can offer. Whether it’s being tied down to strictly scanned content, or in many cases, an architecture reliant on database blobs for the storage of image objects that limit scalability and ultimately hamper performance, the functionality chasm is severe. Imagine yourself in the bed in the ER as your clinician waits for your chart’s scanned images to load for minutes in some cases. Top tier ECM products have been scaling to billions of images and terabytes of data in numerous vertical markets for decades now. So, why might a hospital buy the EMR’s document imaging functionality? Because it’s ‘integrated’. However, whether it’s HL7, Web Services, API’s, or screen scrape technologies, peeling back the layers of an EMR’s ‘integrated scanning’ will often yield little more or even a weaker integration than many ECM’s can provide out of the box.

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1 — Disregard for Adoption.

Most organizations are so focused on trying to get something in production, that they tend to disregard the simplicity and fluidity of user experience that is required to garner the appropriate adoption rates. Adoption is a two-dimensional problem. The first dimension is making sure that a critical mass of users is enabled to access and use the ECM system. The second dimension is that a critical mass of content be available through the system. If either of these conditions doesn’t hold true, overall system adoption suffers. However, for both the number of users and amount of content, simplicity of user experience is the most critical dimension. If a user has to perform additional work to use the ECM system, that he/she didn’t have to do in their old world, more than likely than not, they will bypass the ECM system. Not placing sufficient emphasis on both of these dimensions of user adoption is one of the biggest reasons ECM implementations fail. 

Recommendation: Focus on scaling the number of users and the amount of content with an acute emphasis on simplicity of user experience. Integrate ECM’s back end with social computing front ends. 

2 — Picking the Wrong Business Scenarios.

Most organizations don’t pick the right business scenarios to start with to demonstrate the true potential of ECM. Those organizations that choose the first few scenarios for roll-out based on a combination of strong ROI potential and strong strategic enablement of long-term business directives can drive high (and positive) visibility for their ECM initiatives. It is the demonstration of the transformative potential of ECM to a business that tends to get the right level of enthusiasm from the other business areas.  

For example, if your company is looking to move non-core business processes to a cheaper geography via business process outsourcing (BPO) activity, digitization of content is a necessary pre-requisite and enabling condition. Enabling digitization for BPO will have a higher likelihood of obtaining executive attention than digitization to save file-room real estate.  

Recommendation: Pick business scenarios to start with that: (i) have high visibility at senior levels of management; (ii) offer strong potential for cost reduction or for increasing the top line; (iii) need ECM as a strategic driver to their business rather than a toolset from IT. 

3 — Over-customization.

Doculabs consulted for more than 500 companies across a multitude of highly regulated and complex industries, including life sciences, financial services, consumer packaged goods, utilities, state and local government, etc. Very seldom have these companies recognized the similarity of their operations to those of their peers. Instead, what we hear more often than not is how unique each company is, despite the fact that very few are that different from each other, especially regarding the reasons they could potentially fail with ECM.  

One result of this conviction of uniqueness is that as businesses implement ECM, they tend to over-customize their implementations, believing they are different from the rest of the world in the ways they use information. The net result: long, arduous, risky, and expensive roll-outs, with even more expensive upgrade cycles. If most organizations focused not on meeting 100 percent of their needs with ECM, instead aiming to get 70 percent of their most important needs fulfilled by ECM, the cumulative benefit over a period of time would be far greater than trying to boil the ocean all at once. This seems like common sense, but is very rarely practiced.  

Recommendation: Focus on less custom development; place greater emphasis on configuration.  

4 — One-off Provisioning of Business Requests.

The period from the time a business request comes in to IT to the time users have a functional system is, on average, 12 to 15 months of elapsed time. This extremely slow turnaround time is characteristic of many companies and is primarily the result of the lack of a repeatable implementation process.  

Recommendation: Implement ECM as a shared service so that repeatable, configuration-based roll-outs become the norm.  

5 — Lack of Focus on Proving Business Justification.

A big reason why ECM implementations fail is a lack of focus around quantifying the ROI for ECM. Defining concrete and credible benefit streams and tracking against the model to ensure that the implementations produce those results is the only way to obtain sustained executive support and funding. Most business justifications tend to be either too optimistic to be taken seriously, or too generic to be applicable to an organization.  

Recommendation: Develop specific business justifications with organization-specific data and a defensible heuristic model, showing peer group benchmark data that can be demonstrated to an executive in 10 minutes or less, but with rigor in the back end to be able to support the conclusions. (See Doculabs’ white paper for more details.) 

6 — Ignoring the Impact of User Experience.

Eventually a system either succeeds or fails based on how it appeals to the user emotionally and whether the user is able to imagine the possibilities of a better world as a result of sustained use of a system. Since ECM has such a huge platform component to it, many organizations fail to get clarity in how “a day in the life of” a user will be impacted a result of ECM.  

Recommendation: Build out storyboards or prototypes depicting how a user’s life would be materially impacted for the better as a result of using ECM capabilities.  

7 — Lack of an Overall Vision for ECM.

Most organizations don’t tend to have a sufficiently comprehensive vision of ECM to be able to determine whether their efforts are a success or a failure. A strategy for information management within an organization is largely absent in most places.  

Recommendation: Either develop an ECM strategy, or dust off and refine your existing ECM strategy, especially in light of the rapidly changing landscape of social computing, information governance, and cloud-based computing models.

8 — Underestimation of Cultural and Change Management Implications.

Last but not least, most failures aren’t the result of technology issues. ECM is a mature technology; most ECM suppliers are in their tenth and eleventh major versions of their products. The primary reason for failure is that organizations grossly underestimate the cultural and change management implications related to automating certain business tasks. People have become accustomed to doing things a certain way, and this sort of change can sometimes have a jarring effect. If not properly positioned, the ECM initiative starts off on the wrong foot and never gets back on track.  

Recommendation: Whatever you’re budgeting for change management during a roll-out of an ECM project, simply double it. No matter how much you think you’ve overestimated the effort, trust me when I say you’ve probably underestimated it by a long shot! 

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