Addressing the Whitespace: Digitizing the Missing Pieces of the Medical Record


Therasa Bell, president and Chief Technology Officer, Inofile, healthcare technology, Meaningful Use Stage 2By Therasa Bell

Many Pennsylvania patients will start their next visit to the doctor’s office the same way: by filling out registration paperwork. This simple act adds up to a big problem for the healthcare industry. Despite $19 billion of incentives to push digital patient records forward, many offices are buried in paperwork and other unstructured patient information that often fails to make it to the electronic medical record – whether it is paper, fax, a digital image, email attachment or smartphone app.

That doesn’t mean there’s a lack of effort to digitize these pieces of the patient record. In fact, there’s too much effort. Every source of unstructured content requires time-intensive processes to convert it into a standards-based format that any provider can access.

Typically, this process means a member of the staff scans every page, keying in patient information and other relevant details to ensure the file makes it to the right record and remains accessible. Beyond the time spent scanning and keying, the equipment also requires regular IT support to maintain functionality. And all of this must be in place before a single item is converted and connected to the correct medical record.

If the doctor is a specialist, the new patient was probably referred by her general physician. While she fills out brand-new paperwork detailing everything imaginable, the referring office will be sending relevant patient history, usually via fax machine or server. 

While fax technology is outdated, it is also ubiquitous – ranking as physicians’ second most popular way to share patient information. Whether sent via paper or electronically from a server, fax content can be hard to read, harder to file and does not meet any interoperability standards. That means every time a paper fax is sent, it requires a similar time-intensive process of scanning and keying before it can be absorbed by an EMR or information management system. The other option is to leave it in the file as paper, where it cannot be easily searched, acted upon or contribute to simplifying the process.

When most providers just want to simplify the practice of healthcare, this level of time, money, people, and technology becomes a lot to manage. 

That’s one patient at one medical office and one source of unstructured content.  Multiply that by an estimated 330,000 group practice physicians across the nation and their daily stream of patients. Then add the other unstructured content these medical offices must capture. Keep in mind this is just medical groups — not hospitals, health care systems, long-term care/post-acute providers or any other member of the health care spectrum. 

At best, this is a staggering inefficiency. Imagine how much time and money could be saved if healthcare resources weren’t dedicating so much time to scanning, converting and filing. 

At worst, this process is jeopardizing patient care and safety. Each extra step increases the odds that the file won’t make it to the appropriate destination. And with IBM estimating that 80 percent of medical data will be unstructured in 2015, these problems will increase unless care providers take the right steps.

With this in mind, here are a few steps healthcare providers should consider:

Identify the sources of unstructured content: This not only includes fax machines, fax servers, scanners, printers, medical devices and other hardware responsible for producing both paper and unstructured digital information; it also includes external care partners. What technology do they use? Is there a common platform for sharing patient information securely and digitally? This is a requirement of Meaningful Use Stage 2, so there are a variety of options available to address it.

Determine existing resources and capabilities: Some EMRs have limited information exchange capabilities. Leading medical information networks may also offer resources or recommend partners. Ensure these solutions can handle all forms of unstructured content and meet healthcare technology standards to avoid additional investment or costly upgrades.

Consider the financial and staff costs: Many healthcare IT departments are recovering from or currently implementing large-scale EMR implementations (hence the term: “IT Fatigue”), limiting both financial and on-site resources. Factor these elements in to determine the overall investment, including the impact of change the process might have on your employees for training, workflow changes and additional disruption. 

Examine all of the benefits: Quality care and patient safety are obviously critical, and both rely on a complete patient history. This means any solution should directly address all types of unstructured content and connect with your information management system to improve efficiency. This translates into better patient care and enables providers to better manage staff resources and schedules. 

While the healthcare industry has made considerable advancements with digital medical records, every provider will continue to face a surge of patient information that doesn’t fit into an EMR without some effort. Those who understand the impact of this unstructured content today will be the most prepared for tomorrow.

Therasa Bell is president and Chief Technology Officer of Inofile, a healthcare technology company that creates vital links to simplify healthcare. Bell is a thought leader in the healthcare information technology field, serving as a co-chair or member of healthcare IT standards committees that influence national and international standards for sharing clinical information. In 2009, she defined and pushed through a healthcare IT protocol for unstructured clinical content, which passed as part of legislation for the Meaningful Use Stage 2 section of the HITECH Act.