Originally published on InContext, a Lexmark website. 

ecmIndustry analysts project healthy market growth for enterprise content management (ECM) solutions across all industry sectors. Gartner’s 2016 Hype Cycle for Real-Time Health System Technologies places ECM squarely along the “plateau of productivity” at the far, right-hand side of the hype cycle curve. This essentially means that ECM software offers a strong value proposition for healthcare providers and is being actively adopted.

This is good news for ECM users and technology suppliers, but what’s next for ECM in healthcare? To remain competitive and leading-edge, ECM solutions at the plateau must evolve to keep pace with a rapidly changing healthcare marketplace and more demanding customer expectations.

Up to 70 percent of the data needed for effective and comprehensive patient care, care coordination and decision-making exists as an unstructured data. This suggests a large chasm exists between resources and effort expended by healthcare providers on EHR technology to manage discrete data and the work yet to be done to effectively automate and access to unstructured content. ECM solutions are evolving in a new direction that offers HDOs an opportunity to strategically build a bridge to this outstanding content.

Healthcare content management (HCM) is a new term that represents the evolution of ECM for healthcare providers. It is the modern, intelligent approach to managing all unstructured document and image content. The biggest obstacle we must overcome in this journey is the tendency to fall back on traditional thinking, which drives health IT purchases toward familiar, siloed and non-integrated systems. Traditional methods for managing patient content will have a diminishing role in the future of healthcare. It’s time to set a new course.

HCM: A primer

  • HCM = documents + medical images (photos and video too)
  • The 70 percent of patient content outside the EHR is primarily unstructured in nature, existing as objects that include not only DICOM (CT, MRI) but also tiff, pdf, mpg, etc.
  • ECM has proven effective for managing tiff, pdf and a variety of other file formats. It is not, however, a technology built to handle DICOM images, which represent the largest amount of the unstructured patient information in question.
  • Enterprise imaging (EI) technologies have traditionally been responsible for DICOM-based content. These include PACS systems and vendor neutral archives (VNA), enterprise/universal viewers, worklist and connectivity solutions that are unique to medical image and video capture.
  • Leveraging a single architecture to intentionally integrate ECM and EI technologies, enabling healthcare providers to effectively capture, manage, access and share all of this content within a common ecosystem, is referred to as “healthcare content management” or “HCM.”

Although the market is ready for HCM and many healthcare providers are already moving in this direction, it is important to know what to look for.

Critical elements of HCM

Although it is the logical first step, HCM encompasses much more than simply unifying ECM and EI technologies into a single architecture to enable shared storage and a single viewing experience for all unstructured content, both DICOM and non-DICOM. Just as important is workflow and how all document and image content is orchestrated and handled prior to storage and access. This is essentially the “secret sauce” and the most difficult aspect of an HCM initiative.

ECM for healthcare workflow is geared to handle back office and clinical workflows associated with health information management, patient finance, accounts payable and human resources. The intricacies of these workflows must continue to accomodate specific regulations around PHI, release of information, etc. The workflow component of ECM is critical and must remain intact when converging ECM with EI technologies. The same holds true for workflows for enterprise imaging. EI workflows are optimized to handle image orchestration from many modalities to the core VNA or various PACS systems, medical image tag mapping/morphing to ensure image neutrality and downtime situations, for example.

These workflow features should not be taken lightly as health systems endeavor to establish a true HCM strategy. Do not overlook the need for these capabilities to ease the complexities inherently involved and to fully capitalize on any investment made.

Guidance for HCM planning

Consider the following recommendations as you plan an HCM approach and evaluate prospective vendors:

  • Be wary of an ‘archive-only’ strategy – A clinical content management (CCM) vs. HCM approach is primarily an archive and access strategy. The critical element of workflow is fully or partly missing. A word of caution to diligent buyers to ask the right questions about workflow and governance of unstructured document and image content before, during and after storage and access.
  • Always require neutrality – Changing standards is a given in the healthcare industry. HCM should be in alignment with the new standards to ensure all document and image content can be captured, managed, accessed, shared and migrated without additional cost due to proprietary antics by your vendor. An HCM framework must have a commitment to true neutrality and greater interoperability.
  • Think strategically – A deliberate HCM framework offered by any healthcare IT vendor should be modular in nature but also able to be executed incrementally and with the end in mind. Beginning with the end in mind is slightly more difficult. The modularity of your HCM approach should allow you to attack your biggest pain points first, solving niche challenges while preserving your budget and showing incremental success in your journey toward the end state.
  • Consider total cost of ownership (TCO) – If a common architecture and its associated cost efficiencies are important in wrangling your outstanding 70% of disconnected patient content, you cannot afford to take a niche approach. It may seem easier and cheaper to select a group of products from multiple niche vendors to try and solve your most pervasive siloed document and image management problems. Take a careful look at the TCO over the life of these solutions. It is likely the TCO will be higher due to factors which include the number of unique skillsets and FTEs required for a niche strategy.
  • Demand solution flexibility and options – Your HCM approach should provide extensive flexibility and a range of options and alternatives that are adaptable to your unique needs. Software functionality is important but not the only criteria. Your HCM approach for strategically managing all unstructured patient content should allow you to:
    • Start small or go big, solving one challenge or many
    • Establish a common architecture with a unified content platform and viewing strategy for all document and imaging content
    • Enable unique ECM and EI workflows, not simply storage and access
    • Hold one technology partner responsible – “one throat to choke” – for easier overall performance management and administration and vendor relations

Providers of all shapes and sizes need to take a thoughtful approach when evaluating document and image management solutions. There is more to it than capture and access. And, when this technology needs to enable up to 70% of your patient and business information, you can’t afford to make a decision without considering the role it needs to play for the healthcare enterprise, immediately or over time.

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