How to Achieve Maximum ROI and Patient Satisfaction via EMR

How to Achieve Maximum ROI and Patient Satisfaction via EMR

July 30, 2013 2:00 pm

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Sandy Vosk and Steven Caruso of ImageDoc USA provide guidance on EMR implementation, intended to improve profitability and efficiency while reducing your risks before, during and after software adoption & implementation.

Title: How to Achieve Maximum ROI and Patient Satisfaction via EMR
When: Tuesday, July 30 @2PM ET
Description: Businesses across all sectors must adhere to increasingly stronger compliance standards regarding information security and privacy of their paper-based and electronic data. The healthcare industry has been held to new HIPAA standards as per the HITECH Act of 2009, creating unprecedented demand for EMR systems. Managing change of this magnitude can become a nightmare if you’re not prepared. More importantly for many of you it is how to get started; where do you find the budget for the initial investment?

This webinar assists anyone looking for a roadmap to an EMR implementation which will improve profitability and efficiency while reducing your risks before, during and after software adoption & implementation. The core topics that will be discussed that can help you maximize the benefits of your implementation: how to get started; finding the resources needed; what to do with your current files and quantifying the benefits.



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April Sage: Hi, everyone. This is April Sage from Online Tech. Thanks so much for joining us for another Tuesday at Two webinar. Today, I’m very happy to introduce the handsome and talented Sandy Vosk and Steven Caruso. They are from ImageDoc USA. Sandy and Steven have had extensive experience in the technology areas with little companies you might recognize like PepsiCo, Mutual of New York, Philips Electronics. And they have joined together today to bring us some information about how to manage in a secure and compliant manner all of the records that many healthcare organizations are struggling to digitize, archive, and manage throughout their practices. So I’ll let them give you a little further background about their company, and with no further ado, let me turn it over to Sandy and Steven.

Steven Caruso: Thank you so much, April. That is a fantastic introduction. Sandy’s laughing here, the handsome, of course, Sandy Vosk. I just wanted to add to the introduction quickly that we’ve been spending the last five years trying to support companies from a financial perspective come up with great solutions so that they could improve their efficiency and maximize their ROI with their electronic documents and software, EMRs, EHRs, and the like. That being said, there is a tremendous pushback and a tremendous need for support in this area, and we’re going to dive right into this slide-show presentation. We’ll cover a bunch of topics. Hopefully, this will be super-supportive and informative for all of our attendees, and at the end we’ll answer all of your questions.

So that being said, I’d like to transition here and get started and really go into our first slide. Information capture: Every industry out there has a need, a growing need, to capture more and more information. Our contact is in hard-copy form, and there is no shortage of need to get out there consistently. This spend is growing. The need is growing, and there’s so much building on a day-to-day basis. It’s growing exponentially. When we look at the growth of the electronic data and we look at what happens in an internet minute, we can really talk to this quote from Google’s CEO Eric Schmidt, and I’ll read it. “Between the birth of the world and 2003, there were five exabytes of information created. Now we create five exabytes every two days.” Think about that. That’s a billion gigabytes. An exabyte is 1 billion gigabytes. Five times that every two days.

We’re not so sure when that was said, so it could be even more than that at this particular point in time. And that’s really the core, the cost here, this growing document dilemma. When we talk about content and paper content, people see files. They see the actual process of managing themselves, but they don’t look at the costs. They don’t look certainly at the risks. When you talk and you look at these bullet points here, it’s outstanding. Jack Welch said it best in a quote from February of 2011, and he talks about “if it doesn’t turn green into green.” What is he saying? Well, in an era of digital documents, in an era of increased awareness and focus on green initiatives, we’re constantly dealing with this paper content, this hard-copy content, and how do we maximize that? If it’s not profitable, it doesn’t gain the main focus, the main priority of businesses. If it’s not profitable, if it’s green or sustainability initiatives, if it doesn’t turn into profitability, it doesn’t get addressed. So we see this building in the industry, in all industries across the board, and we’re at a point right now where there’s these undeniable statistics out there.

There’s this paradigm shift, and this is a slide, and I should have quoted that on the first slide, so I’ll say it here. The first slide was from an AYN webinar that was given briefly, and this information is sourced here from the Aberdeen Group as of January, 2012, but this paradigm shift and looking at these bullet points is really core to the entire message of this presentation and this webinar today. Because when we look at this continuing shift from paper-based documents to digital instruction data, what are the key components? Well, we need to reduce cost. We’re looking for an efficiency improvement. We’re looking to meet compliance regulations, HIPAA, HITECH, everything that’s being thrown at us, and at the same time, we have this conundrum because the volume of documents and unstructured data is growing at more than 30% annually.

When you look at 49% of the basic business processes rely on paper documents and unstructured digital data, and 51% of the business data is stored in paper and/or unstructured digital documents, it causes a real serious issue that we’re all faced with. So what are the issues? Well, what we see across verticals and across enterprises, there’s really no adherence to the corporate-wide policies that were put in place. It’s not because corporations don’t want to, but the previous person employee moved away from their post, and that person who’s now picking it up, they think they have the information right. They don’t, so corporations then look and they say, “How do we image internally?” Well, that doesn’t make sense because it’s not cost effective.

When you look at the cost to simply store these records, it really adds to this growing problem. But the cherry on the cake here is clear. It’s the risk. The recent weather patterns that we’ve been seeing, disaster recovery, business continuity, and the litigation issues, are paramount, paramount in our day and age. When we start to drill down on the different types of risk, we have to focus in on these three key components. When we look at business risk, you know, this file that lost documents, what does that cost us? There’s a study out there that employee breaches, 95% of all breaches happen from hard-copy paper documents.

And we talk about theft and sabotage, and we constantly see organizations that are affected by fire, flood, mold, and these hard-copy assets are corrupted. Just think about the simple things in business whereby you see this visual, and whether this is a medical practice or whether this is a law firm or financial firm, going to find documentation and the labor and the wasted time in managing these assets is just eroding the bottom line for most organizations. When we get into the regulatory components and we start to drill down on all of the HIPAA compliance with regards to retrieval and providing it in a stable setting and really conforming to health-information technology and the requirements of HITECH, it’s really a growing issue.

But the bottom line is if there is a risk or if there is a loss, the key question is how would that affect you? How does that affect your business? How does that impact your organization? So when we talk about EMR and EHR and HITECH and driving, and we look at the amount of conversion in the industry and people that are adopting EMR and EHR because of the mandates and the Act and the timelines, we also see lots of pushback. We also see lots of hesitancy. We see lots of frustration, as well. And it’s very core to this message because when we look at the overall transition, we’re trying to go from this paper state and assess all of the risks, as we just mentioned, comply to all of the regulation, while maintaining our profitability and utilizing that digital data.

And, you know, when we’re in a situation right now in this pure time that we’re in where we have a doctor that has a tablet in one hand and a paper chart in the other, it really moves away from what the primary goal is. The primary goal is clear. It’s all about better patient care and enhanced patient satisfaction in the medical industry. We look at these studies, and we’re not shocked at all. We look at the software industry not at blame, but it is just an evolutionary process. There’s this massive need, and there’s been 17,000 active EHR adopters according to this “Black Book Rankings, February, 2013, Report,” and that’s an article that we’ve sourced. When we look at 17% of the medical practices could be switching out in their first year of their first choice of EHR, and they’re considering that 80% said the solution does not meet the practices’ individual needs, or 79% indicated that the medical practice hadn’t adequately assessed the group’s needs before choosing the EHR, 77% of the respondents cited the solution design really wasn’t a match, it’s ill-fitted for their practice, and 44% of the vendors said that … 44%, excuse me, said that vendors were unresponsive to their requests, what does that mean? Okay. It means that we need to really understand this transition, and we need to understand that it’s not solely about the technology. I’m going to have Sandy Vosk explain this next slide because he’s been a master of change management for over 30 years, and he could talk to this slide from a serious amount of professional experience.

Sandy Vosk: Hi. Thanks for having us today. I’ve been in the IT industry for about 30-some odd years and my own business for 10 years, so I’ve been preaching this slide over and over, that it’s not about the technology. It’s about managing change. Really, the technology is an enabler and only … it looks like they have three equal concentric circles. It’s really the technology perhaps is 20%; 80% of the success will be about people and process. If people resist the change, it won’t occur. If you don’t look at all of the core processes involved and only focus on the new software and the features and functions of the new software, you won’t get the business impact that you’re seeking.

That’s why it was so wonderful to see Dr. Ficken … I’m probably going to mispronounce his name … Fickenscher’s quote because this is the issue even in healthcare. You know, you can’t be speaking about the technology stuff. How do we help, whether it be hospitals, OB-GYNs, every element, manage this change from moving from a paper-oriented office and system to seeing the benefits of the technology, gaining the benefits of the technology, instead of being the victims of it. That’s why what we wanted to do is help today and provide a framework, a roadmap for how do you get there, and I’m going to hand that back to Steve now.

Steven: Thank you, Sandy. You know, how do we get there, and what do we really need to be looking at? Now, we’ve spent a lot of time with C-suite executives talking about the financial components of this whole problem, and what really goes under the radar is the amount of labor costs and the amount of hidden costs when you talk to record storage, when you talk to inefficient ROI on their EMR, and when you talk to all of these different components. When we look at key bullet points in this slide from IDC’s 2010 studies and we see that $12,000 per year per employee is typically spent trying to find information and looking for it and trying to carry out the retrieval of that patient and it says one thing: why aren’t we looking at the financial assessment?

So this key question here is a component to all of what we need to learn from this webinar, and the key question, “Have you ever done a financial assessment to find out what you’re really spending?” needs to happen first so that we can identify these costs. When we get into this identification process and we really drill down and we talk about the wasted spending, money that’s being wasted month over month simply from documents that have been kept past the retention-policy requirements that could be destroyed and that don’t need to be in the system, and when we identify that the funds from labor that’s being wasted and that could be moved or shifted, that could minimize the investment on your EMR by imaging these records as your business needs and by getting rid of what you don’t, those are key.

Really, once we have these costs assessed, it could really determine the proper decisions because without the financial dashboard, you really can’t make the proper decision. The soft benefits sometimes even exceed the hard benefits. What happens when you have the information at your fingertips? In a medical setting, the value of having key medical information at your fingertips, after the MasterCard commercial, it’s priceless. So these soft benefits really have to be addressed as well in this whole identification process and finding out what your true costs are.

So how do we go about, then, dealing with change, as Sandy talked about, and process and people and combining with the technology? You know, for years we looked at a chip to document … to outsource in general. We’ve outsourced our payroll. We’ve outsourced our health insurance. We’ve outsourced many functions in our business day-to-day processes. What we also see growing, clearly, is the document-outsourcing industry, and we clearly see more and more of a need because companies need to focus on their core competency regardless of what that is.

We found lots of results, and we talked about helping many, many organizations with this exact need. We’re going to share some of these case studies with you. I want to drill down on the bullet points, and we’re going to go bullet point by bullet point here and talk about it because it’s pretty funny to have all of this. It’s synonymous, right? Regardless of the vertical, regardless of the industry, all of the needs are pretty clear.

In this first case study, number one, the client’s critical issues were they needed to improve their efficiency. Core business was impeded by a lack of access to critical information. There’s no central repository of information, and there were no central policies. They had unabated growth, budget growth, and they had unmanaged liability across the organization. So what we looked at was how do we identify their inventory and their historical records. What could be destroyed? How could we eliminate spending on storage and retrieval wherever possible and use that storage and labor savings to pay for their imaging requirements, securely move the identified records to get scanned, and then when they needed to be shipped back, they were, rather than destroyed? Of course, then we set up an ongoing imaging-and-retention program, and it eliminated the need to return to their status quo. Okay?

So why’d they choose their outsource vendor? It’s core. You can’t just buy something. You need to really do your due diligence and work with somebody that is going to come from an advisory approach and provide the thought leadership to help develop the business cases best suited for that organization, that have the experience to do it and the project-management capabilities and, of course, established a trust with your outsource vendor. The results were staggering in this case: 40% savings compared to the best pricing of all the vendors, they had a $5 billion spend on their HDO system, or they were enabled to do that, and they met their green initiatives. Pretty significant findings here.

But, again, the soft benefits sometimes are greater than the hard benefits when you talk about the reduction of liability and you talk about the reduction of insurance costs potentially of the facilities and you’re eliminating the amount of time and hassle related to access files and the reduction in consumables. Organizations, major organizations, Fortune-level, it’s not uncommon to consume a million boxes of paper. It’s not uncommon for a major Fortune-level company to spend eight figures on ink and toner. When you talk about the reduction in consumables, it’s significant and not nearly as significant as the reduction of real-estate costs and software and equipment and labor costs. Really, it’s about focusing on the client’s core business, and that’s the key benefit. That’s the key soft benefit that cannot be quantified.

Now, when we go shift into case study number two, we looked at a large medical practice that invested hundreds of thousands of dollars in their EMR, and they weren’t prepared for the change. Sound familiar? It sounds familiar to most folks, as we discussed in the previous slide. You know, doctors weren’t proficient in using the EMR. None of the patient charts or the content was uploaded for use. Staff providers were completely frustrated in the transition process, and patients were also becoming frustrated and began to become irate.

What was the proposed solution? Well, first step, as always, completed a complete financial assessment of the cost to manage the files and the charts. Direct the practice to schedule training. If you don’t know how to use it, you need to really become proficient at it. Inventory and identify all the access, on all the charts that were being accessed and created a schedule to image into their EMR without an interruption to their practice. We eliminated a lot of the spending on the storage and retrieval wherever possible, and, then again, we used that savings to pay for their imaging requirements. This particular company scanned the four most recent years of patient charts for use in their EMR. Okay?

So they initiated an ongoing retention program, and we’re going to move into what happened here and why the clients still like the outsource vendor. Well, it was clear, support and consulting, strong ROI, great project management, and what were the results? Several hundred thousand dollars in savings over five years, maximized their ROI, and then you’ve got some native to their EMR, and they brought … You know, this bullet, this last one bullet, this little bullet right here, “brought emotional satisfaction to their practice,” that’s really key. I mean, how do you quantify that? How do you quantify a smooth-running business? That’s really core to what we’re talking about here.

Let’s move into this third case study. An OB/GYN practice invested hundreds of thousands of dollars in an EMR business, and they determined that their staff would conduct the imaging in an attempt to leverage their benefits. Well, the staff wasn’t trained. Scanning sounds easy, okay, but they weren’t professional in scanning and capturing and indexing. After six months of chaos, they realized they needed something else. So what happened? Well, conduct a financial assessment again. Find out what the costs are, the total cost of ownership, and we’ve got lots of data and third-party information that supports outsourcing, as well. Okay? We created the project timelines. We identified what needed to be scanned over the past two years, and we repurposed that spending. Of course, they used that spending for their imaging requirements, and we initiated an ongoing imaging-and-retention program.

What happened? What were the results? Well, again, $200,000 in savings over five years, and they maximized their ROI from the investment made in their EMR, core to what we’re speaking to. Okay. So the benefits are pretty clear. They’re not pretty clear. They’re crystal clear when we talk about immediate cost reduction and increased profitability and improving operational efficiency, dramatically reducing business risk. And really, what this is all about here that we’re talking to today is maximizing your ROI on your EMR investment. The ultimate goal and the ultimate benefit is to have improved patient care and enhanced patient satisfaction because in the medical vertical, of course, and in this case, when we talk to EMR, that’s the ultimate goal.

So, in summary, and we’ll talk to these bullet points, like Sandy said, “It’s not about the technology, but it’s managing the change,” and you need to choose a technology partner that is experienced and especially one that you can trust. The best ROI results from the financial assessment happen before you purchase something. We need to know what we’re spending so that we can make the best decision. We need to review and validate all of the record-retention policies and, as well, the frequency of retrieval before we consider anything as a conversion candidate. And we have to determine what’s critical and where it should be stored and for how long. Most importantly, it’s not about getting everything digital. It’s about understanding what’s important to get digital. Not everything will be or should be stored in an EMR. That being said, April, I guess you want to talk a little bit to the contact information here and this upcoming webinar, or do you want me to go right into our questions?

April: Let’s just move right on into questions, and we’ll show your contact info, as well. I’ll do a really quick invitation to our guests to check out our upcoming webinar about encryption and the legal impact on healthcare organizations, but we’ll send out some info about that by email later. So let’s go ahead and address any questions that folks have. I have a couple on this side. Let me first say thanks very much for sharing that perspective, and I love how you begin with the business conversation. You’re cutting right to the chase, starting to talk with the business kind of at the point of their bottom line by doing the financial analysis. I have to say, I think that that approach is one that we see severely lacking on so many circumstances throughout the industry, but especially in healthcare.

You know, the point that you brought up about the vast majority of breaches happening because of the loss or misplacement of paper documents is something that I think is unintuitive. We hear so much about cyber-security and hackers and threats that I think the natural assumption is that this patient information is kind of disappearing invisibly over the internet, but the evidence shows us that the biggest area of mismanagement is clearly with the paper record. So it sounds like that is really the area that might be still at greatest risk.

Steven: It certainly appears that way, and all of the studies that we, in all of our experience, we clearly see that. Over and over again, we’re reminded about … the technology is fabulous. Thinking about all of the different EMRs out there and you think about all of the benefits and the features that they have, it’s outstanding. Each and every one is amazing, but without the content in the software, you’re not maximizing the utilization of that software, and really, that’s what the … If we can maximize the ROI on these investments and minimize the risk, obviously, every business would benefit from that.

April: Now, what are the biggest mistakes that you see organizations making as they try to tackle moving their paper records into a digital form themselves?

Steven: You know, it’s a great question. So many clients and so many folks out there think that it’s an easy task, and as much as they love the software and they want to rush to the software, they’re not prepared to make this conversion process. So what are the things that they have to consider? We have third-party research that we can supply to you or anybody else that shows what I’m about to speak to. You have to set up an infrastructure to scan. You have to have the internet bandwidth in order to support that. You have to link to the technology. You have to be able to know what the capture software does. You have to have people that are proficient in QC. You’ve got to have storage, and you have to have a room in your facility in order to do that. You have to have properly-trained staff. You have to move away from your core competency.

If a doctor’s practice is to practice medicine, why would they have a scanning suite? If a law practice is out there practicing law, why do they have a scanning division? What are the costs associated with that hardware? What are the costs associated with that software, and then the labor-cost component, as well? When you work with the proper outsourced vendor, you could meet those costs or get a better cost at an even lower price and have the efficiency of not having to deal with it yourself.

Just like I said before, when we talk about the document-outsourcing market growing, do we conduct our payroll today? No, somebody else does our payroll. Why should we deal with transitioning our documentation? So those are some of the issues, April, that we see out there, and it’s pretty clear that the educated consumer does not want to tackle this. Any educated consumer looks at this and says, “This is a major process. This is a major distraction to our business. We need professional help.” That’s really what they overlook. Most businesses need to look at professional support and direction.

April: Now, without naming any names, what percentage of your clients try to tackle this themselves, versus taking that kind of strategic look before they get knee-deep into trying to scan?

Steven: You know, the statistics show that there’s a pretty even mix out there in the 40% to 50% range on both sides. What we find is that most people that try to tackle this, percentage-wise, a good margin then have to outsource, regardless. So they set up to image. They set up to transition. They set up to maximize their ROI from their EMR investment, and then they realize they have all these QC/QA problems. They realize that they have human error. They realize they have this budget problem and they’re not on target, so this money gets wasted. I’m not saying that there are not successful folks out there that utilize great technology, great hardware and software, and hire trained staff to do that, but more than not, we see issues with that conversion. Sandy wants to add to that.

Sandy: There’s really two sides. What’s really important, and we haven’t really focused on this in the webinar up to now, is most of the technologies, whether it’s cloud computing, EMR, are a go-forward strategy. Companies, medical, everybody is buying increased technology that provides scanning, the ability to fax, email, and it’s great as a go-forward strategy. It’s not great as a back-file conversion strategy. And to assign labor, whether it’s office labor or summer interns, to the task of converting your old information or paper-based information is not to be minimized. It’s key information, and it needs to be handled in the proper way with the proper focus so that it becomes part of your intellectual property, your key business information that you need to run your business on and to be able to pull up information if you’re asked to from a compliance perspective. So that’s what I wanted to add.

Steven: No, that’s a great addition, Sandy. That’s a great addition. Peple ..

April: A very important point as far as compliance and process-oriented. That’s great info. Thanks, guys. Steve, were you going to say something before I interrupted you there?

Steven: No.

April: Great. Well, I have just one last question here, and we’ll wrap it up. I’m sure each client and business situation is different, but typically, how long do you find it takes to be able to get a practice or an organization caught up with their last year or two of recent data once you have proved the business case and formally started an engagement?

Steven: That’s a great question. How long does it take is really dependent upon how much cooperation and how much emphasis and priority the business management and the decision-makers put on the project. If they really want to focus in on gathering all of the information and doing the assessment quickly and that is done and the presentation of the findings is made where core decisions can be made to proceed and they have a clear road map, the conversion process is fairly simplistic and timelines typically range from four weeks to eight weeks from the actual transition-project start to finish.

That means whereby documentation is gathered, it’s shipped, it’s transitioned, it’s digitized, data is shipped back, and then the business decision, the business owners now have their functioning collateral and all of their content in a position where it could be used by their EMR. From the beginning to the end of that process is typically a quarter or 90 days on the average business that we’re addressing, small to medium-sized businesses. Large companies, Fortune-level companies, it could obviously be much longer, a year to two. But we’re addressing the small to medium-sized business primarily.


April: Well, that’s a great perspective, and one last question. I thought of it as I came in here. Yes, we are recording this webinar today, and we will be sending a link to the recorded webinar within the next day or so. If you have any further questions, I encourage you to reach out to Steve and Sandy. Thank you both so much for sharing your perspectives with us today and expertise, and we look forward to knowledge-sharing with you again in the future. Steven: Thank you so much, and thank you, everybody, for attending. I hope this was informative, and we wish you all a great summer.

April: Have a great afternoon, everyone.

Steven: Bye-bye.

Sandy-VoskSandy Vosk, COO, ImageDoc USA

Sandy has an extensive 30+ year track record of executive success including Fortune 500 and international corporations such as PepsiCo, Mutual of New York and Philips Electronics. His broad range of technology and industry experience includes application development, executive management, 24x7x365 operations, global project management, strategic consulting and sales. As COO of ImageDoc, his balance of people, process and technology skills have been instrumental in delivering innovative business solutions and exemplary customer ImageDoc partners and clients. Sandy is a recognized thought leader in the supply chain industry, frequent speaker at national industry conferences.

Steven-CarusoSteven Caruso, President, ImageDoc USA

Steve is a financial industry veteran who spent over 20 years in the securities industry, where he held managing director, partner, and senior vice president positions. As the president of ImageDoc, over the past five years he has developed innovative financial solutions helping executives within Financial, Healthcare and Government sectors reduce their overall records management expenses, significantly improve their operational efficiency while dramatically reducing their risk.


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