Health Records are Going Digital

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SSON interview with George Abatjoglou, COO, and Bill Sweeney, CTO, of IOD Incorporated

Abatjoblou and Sweeny

[Learn about "capture-driven processes"]

BH: Bill and George – thanks for joining me today. Could you start by describing IOD’s business and, in particular, your client base?

GA: Our customers are hospitals and clinics across the country and the services that we provide are broad-based standard health information management services. There are three main areas: the first being the release of information; the second, document imaging; and the third, coding and abstraction, including ICD-10 Consulting and Education Services. All focus around the medical record and a number of business workflows that need to happen with that medical record.

Anyone who’s been to a hospital knows there is a mass of forms to fill out, and that is just on the front end. The documentation that is involved in this industry is enormous. So what kind of problems are your customers generally facing?

GA: There are two problems that our customers are trying to solve. First, there’s a significant move, as everyone knows, to the electronic health record as a result of stimulus money that the government included in the Stimulus Act of 2008 to achieve meaningful use of electronic health records. However, the reality is that paper is, and will be for the foreseeable future, a significant part of the medical record. To get to a truly paperless or electronic environment you need to digitize the paper content, combine it with the electronic data that is the clinical content from the EHR, and then you can build a whole series of workflows and automation around a truly electronic environment.

Our customers are trying to get to that electronic environment with a clinical care purpose, but there are also a number of cost-cutting initiatives underway in healthcare. In particular, there is a focus around some of the business processes, and the automation of business processes, that can happen once you move to a digital environment. Getting to an electronic health record quickly post-discharge will drive that business process improvement. So those are the two main drivers for digitalization in healthcare.

So there’s a move on the customer side towards process improvement. How are you supporting the transformation?

GA: The biggest impact we have is that the move to electronic health records and digitizing the paper and all of that, is really outside the core domain knowledge and expertise of our customers, and of healthcare organizations in general. We’ve been in this business for 30-plus years, and we’ve created a series of best practices around digitizing the paper record. We combine that with technology – our own proprietary technology for workflow management as well as technologies from partner organizations like Kofax, on image capture. The result is that we provide visibility and transparency of the whole process, from a timeliness perspective as well as a quality perspective. The combination of people, process and technology gives us some of the lowest turnaround times and the highest quality in the industry. For some of our customers, the time between patient discharge to the time that the paper record is available in the clinical and document management system is just six to eight hours. And then all of those workflows that kick off from there can begin.

In terms of the services that you’re providing, are you seeing a change in what clients want you to do? Is your market expanding, in light of the digital technology that’s now available? Much of the industry’s focus is now on end-to-end; how are all these changes impacting your relationships with clients?

GA: A lot of the focus is specifically around medical records and the paper component of the electronic health records for our clients –things that happen within the Health Information Management [HIM] department, the group that’s the custodian of records. That’s been the first area of focus for most of our clients in the market, because it ultimately has the biggest impact on patient care as well as return on investment.

But as soon as that need has been met, the clients are realizing that there are a number of other areas where they can move outside of HIM, and take those same best practices and those same processes and apply digitalization and automation to realize benefits – areas like human resources, purchasing, the business office, and billing and remittance. So we’re starting to expand our use within the customer-base, as customers begin to realize the benefit of digitalization.

Customers obviously see the changes that are going on in the marketplace and demand more from outsource service providers. We are seeing this across industries. To what extent is including an outcome-based commitment part of the agreement?

GA: We’re very much service level driven, and the most important service levels for our customers are turnaround time, quality, and cost. And so we’ll put service level commitments in place for our customers, of 24 hours or less, from time of discharge to the records being available in the document repository. We have some of the most aggressive service level commitments from a quality perspective of anybody in the industry. We’re able to do all of that because of the technology and the business process that we’ve deployed in the overall image capture environment. So I think from an outcome-based perspective, it’s really about providing the best quality as efficiently and as quickly as possible.

You mentioned one of your partners, Kofax, earlier. Can you describe your digital strengths, and where partners like Kofax add value to your solutions?

BS: IOD is leveraging the knowledge that we have to build technologies that make us 30% - 40% more efficient for all the key services. We are applying Kofax’s KTM technology to drive a major piece of that transformation. We didn’t have to build the platform ourselves; rather, we took our knowledge and turned it into a system that we can really drive. At the same time, we’re reducing the friction of implementation processes and we’re streamlining and upgrading underlying technologies, and how we transact data with our customers. Those are really the key innovations – taking technology and using it to transform our current process so that we can have higher quality and be more effective.

What kinds of innovations are driven through this partnership?

BS: What Kofax does for us is it really gives us a platform to deliver on those service level agreements that our customers have come to expect from us. And it allows us to increase our productivity because we can automate a significant portion of all those functions, the document preparation, the indexing and all those components that we perform daily. At the same time, it’s a platform that integrates with our own applications, so we can catch errors in advance; we can drive up our productivity; really, what it all amounts to is a higher quality of service.

And finally, it’s a great platform for us to release content back into our customers’ EMR based on some of its built-in tools. Now for me as the CTO that means we didn’t need to build and maintain our own digital platform. By partnering with Kofax we can stay focused on providing our health information management services to our customers and Kofax can focus on providing all the tools in our document management, so it’s a very good fit for us.

We’ve talked a lot about what you’re providing to customers, but what about the customer? Do you come across hurdles on the customer end that limit what could be done?

GA: That’s an interesting question. Healthcare organizations are very political and so the ability to effect change to something as simple as a document and what a document looks like becomes a very political process. So many of our customers could realize significant improvement in their efficiency and quality by doing some basic things such as bar-coding all of their forms so that the Kofax image capture technology can read it and can pull the respective metadata out of it.

But getting those changes pushed through the political environment, if it’s a hospital or a healthcare organization, is very challenging, and so our customers are looking to us to find other ways to realize those benefits. That’s where improvements in accuracy and quality and information gathering from managing the process come into it. And that’s where the Kofax KTM platform was a key driver for us moving to that platform. It’s using the intelligent documentation recognition capability that makes it possible for us to gain the benefits that would otherwise be gained from things like bar coding.

I think, generally speaking, that our customers are looking to us as the expert, as the organization that’s going to come in and say, "These are the best practices that you need to follow in order to move to a very timely and seamless environment, from patient discharge to content being available on the financial systems the clinical systems". And then, where possible, they’ll change their workflows or their process, or they’ll outsource functions like chart collection to IOD, so that we can provide those services to them. They want to focus on providing the best patient care and the best patient experience, and they’ll look for partners to fill in all the other operational gaps that aren’t core to that mission.

My final question is this: As you see the changes in technology that are having such an impact on your industry, as well as others, how do you imagine IOD might be operating in ten year’s time?

BS: The business process and the technology are feeding off each other and you’re going to see significant change in the next five, ten years. So if you think about it, the standard process of the past was to digitize the content after the workflow was complete, and just put it on an electronic shelf. Today what we’re doing is digitizing into a process, and we’re driving the process. In the next few years what you’re going to see is that the point of capture – it’s going to be driven back earlier and earlier, to the point where one process begins and another ends seamlessly; it’s really going to be almost indistinguishable.

For medical records and medical record management, what that means is that you’re going to see a shift towards the adoption of standards for document exchange like docx or clinical document architecture, and you’re going to see the production of things like CCDs and TCRs which are continuity of care documents. And it’s going to mean that medical information will flow securely to where it needs to be, and it’s really going to become about the management of that whole document process as one seamless flow of information.

I think there’s a lot that industries can learn from each other. Health Information Management is by necessity under immense pressure regarding timeliness and quality, and I think this has driven a lot of the innovations you’ve described. Much of what you’re doing will be very interesting to people in completely different industries. Bill and George, thank you so much for your time this morning. It’s been most interesting talking with you.

GA: Thank you, Barbara.

BS: Sure, thank you.

To learn more about "capture-driven processes" check out our Kofax-sponsored series.

About George Abatjoglou

George Abatjoglou is Chief Operating Officer and responsible for the overall operations leadership of IOD, overseeing customer sales and service activities, strategic product planning and marketing, information technology, support and implementation services as well as finance and administration.

Before joining IOD, George served as Chief Executive Officer of eWebHealth Inc., a provider of electronic legal health record workflow solutions delivered via software as a service. From 2001 through 2008 he served as the Chief Financial Officer and head of eWebHealth product operations for ChartOne, a provider of Release of Information and related medical record services. George earned his certified public accountant credentials at PriceWaterhouseCoopers in the early 90s and served in numerous financial leadership positions prior to joining ChartOne.

George holds a Bachelor of Science degree in Accounting from Miami University.

About William Sweeney

As Chief Technology Officer, William Sweeney is responsible for all business systems, professional services, technology strategy, information technology security, software development and the customer support services that underlie and complement IOD’s services business.

William is a Microsoft Certified Systems Engineer and Cisco CCENT with more than 12 years of experience in healthcare information technology, security and healthcare service delivery. Prior to joining IOD, William was VP of Operations at eWebHealth Inc. where he was responsible for software quality assurance, the overall service delivery operations, including post-sales implementation activity, business consulting and technical operations at the data centers that delivered eWebHealth’s SaaS offering.

Before eWebHealth William served as the Director of Technical Sales and Implementation at Wellogic, a leading vendor of health information exchange, physician portal and EHR/PHR solutions. He also served as the Director of Application Services and Information Technology while managing an international telemedicine network at WorldCare Technologies.

William holds a Bachelor of Arts degree in Social Thought and Political Economy from the University of Massachusetts at Amherst.