EHRs & Managed Print Services

Increasing demands to cut hospital costs without affecting patient care is being scrutinized by U.S. healthcare leaders. Every function in a hospital should be under the microscope because each one has a cost impacting the quality of patient care. In today’s financial climate, any processes left unchecked will result in the expenditure of scarce funds at the peril of the hospital. Adding to this dilemma is the federal mandate for Electronic Health Records (EHRs), which requires tremendous investments in capital and human resources in an already overextended IT department. Overlooked in this conundrum are output/print environments and print-related expenses. Both play a significant role in cutting costs and increasing the quality of EHRs. Although low on the priority list for hospital executives, this mindset needs to be reset. There are millions of dollars in savings available by controlling and managing print-related assets and costs and furthermore, “.the conversion of U.S. hospitals from entirely paper-based to a completely digital environment still has a long way to go.”1

The Fax
According to the Healthcare Information and Management Systems Society (HIMSS) Analytics, as of September 30, 2013, only 120 hospitals, or 2.2% of the 5,347 tracked by HIMSS, have achieved Stage 7 meaningful use, meaning medical records are fully electronic, according to its EMR (EHR) Adoption Model.2 During that same month, the organization released the results of a survey of “senior information technology (IT) executives from randomly-selected U.S. hospitals” which found that the most common means of sharing patient information is by fax,3 confirming that paper-based data plays a prominent role in the exchange of health information and therefore should be managed for costs and efficiencies. Yet, most of those surveyed reported that their output/print environment was not a priority in their organization’s strategic plan. The conflict between the mandate for EHRs and the use of a fax machine as the number one means of sharing patient information needs to be resolved. Hospitals must reconsider their priorities when it comes to print environments and realize that there is direct synergy between all means of sharing patient records – print and digital. Integrating output/print with new advanced technology is the necessary solution for the exchange of information for healthcare organizations for medical, business and operations purposes.

Print, copy, fax and scan devices are no longer ‘just’ pieces of hardware. They are highly sophisticated machines operating with a combination of multiple software and applications. Forward-thinking hospitals are adopting Managed Print Services (MPS) programs as a proven strategy to streamline a hospital’s print environment in order to reduce costs, maximize efficiencies and integrate new technology and devices to ensure maximum connectivity, interoperability and reach the ultimate goal of EHR compliance for meaningful use. MPS, as an outsourced business strategy, controls and manages the cost of print and improves the document production process that reduces volume and waste and in so doing, maximizes patient information workflow by continuously monitoring and managing every piece of paper and its use by caregivers.

How Much Are Hospitals Wasting on Print?
The average monthly print volume of a large health system with multiple campuses can reach nearly 12 million documents.4 Even a community hospital with one campus prints just about 1 million pages approximately every 30 days. Industry analysts concur that unnecessary printing is responsible for millions of dollars in healthcare waste, yet rarely do hospitals know the true cost of print-related expenses. There is typically no transparency of spend, nor is there centralization of costs due to the fact that print environments have historically been split between IT and Materials Management departments. In some cases, even these departments lack controls and hospital employees order devices, services and supplies at will.

For healthcare executives truly intent on investigating all means by which to cut costs unrelated to direct patient care, MPS has been tried and tested. As an example of potential savings via a MPS strategy, consider this scenario: If a three-campus, 1,000 bed hospital system produces 4 million documents per month at a cost of $.043 per document, they can expect to pay $174,000 per month on printing. By outsourcing the management of its document production, that same hospital system could cap the document production cost to $.035 per piece, realizing a 20% reduction in costs every month, with the end result of over $400,000 in savings per year, or $2 million over a five year term.

The healthcare industry is among the highest users of output/print and are spending millions on the production of documents without the slightest clue as to the cost, including those care organizations that have a semblance of an EHR in place.

The print process is the low-hanging fruit that has come to the forefront especially for hospital IT departments that are leading EHR conversions, but still realizing that document production is not going away. By implementing a MPS strategy, hospitals will not only drastically reduce their expenses but they will add value to already stretched IT departments to help them reach their goal of EHR compliance easier and faster.

Print Strategy Proves Integral to EHR Implementations
There is an inherent connection between hospital print infrastructures – devices, people, processes and technology – and implementing an advanced technology enterprise-wide strategy. Both print and digital forms of data are inseparable to the flow of sharing patient information. Having a strategic MPS plan in place will better position a hospital to integrate and align new advanced technology, i.e. CIS, EHR software, with output/print processes and technology to help achieve interoperability and desired improvements in process efficiencies and end-user productivity and satisfaction.

Case in point: As part of a massive clinical technology and electronic records transformation initiative5 at Barnabas Health, a six-campus integrated delivery network in New Jersey with approximately 4,600 physicians and 18,200 employees, MPS experts took on a number of critical projects to help overcome challenges and provide cost-avoidance opportunities for the system during the life of the project. While continuing to manage daily print-related service requests and other work, the MPS experts:

  • Mapped and renamed printer drivers ranging between 500 for smaller campuses to upwards of 2,000 computers for larger hospitals,
  • prepared device applications and drivers for integration with the software technologies,
  • validated the printer and computer interfaces for each facility,
  • tested the output of documents to ensure on-demand formatting accuracy for physician-only devices and all others device output/print, and
  • evaluated real-time data and change management processes in the system’s print environment to seek opportunities to address print-related expense and volume reduction opportunities, and subsequently made improvements in process efficiency.

Moreover, the MPS experts provided Barnabas Health significant cost avoidance. Print environment specialists worked nearly 800 hours performing tasks related to the pre and post implementation of the go-lives that would otherwise have been performed by Barnabas Health IT staff.

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Given the demands and investment of time and money to comply with EHR federal mandates for meaningful use, the prominent role paper has in hospitals and the significance of integrating all means for the exchange of information, it is imperative for hospitals to realize that an MPS strategy will work to their advantage all around – savings, volume reduction and EHR readiness and execution.

Forward-thinking Action Steps
Hospitals leaders must make their print environment a priority in order to improve the exchange of patient information, reach their ultimate goal of compliance with federal mandates for EHRs and drastically reduce expenses. The reality is that paper is a prominent and necessary means for sharing patient information and is here to stay. Devices that produce paper volume must be assessed and streamlined for maximum interoperability with advanced technology. Having MPS experts on an EHR implementation team will provide cost-avoidance, problem-solving, free up IT staff and align all means of patient information sharing to be integrated electronically and in print.

Finally, it is vital to remember that the goals of MPS and advanced HIT are fundamentally one in the same: reducing paper volume and costs to ensure more precision in the exchange of patient information and improve the quality of patient care.

Joseph E. Sullivan is National Client-in-Residence for AUXILIO, Inc. Sullivan is a 25-year hospital executive and the former senior VP & CIO for Barnabas Health in New Jersey. He is a member of HIMSS, a past member of the College of Healthcare Information Management Executives (CHIME), and is a past member of Healthcare Information Systems Executives Association (HISEA), serving as its Chairman in 1997-1998. Sullivan earned a BS in Marketing from the University of Bridgeport in Connecticut and he is a graduate of the Management Development Program from the College of Business Administration at Northeastern University in Massachusetts.

1. 2013 HIMSS Analytics Report: Barriers, Challenges and Opportunities with Information Sharing in HIEs: Output/Print Environments, sponsored by ASG
4. AUXILIO, Inc. Proprietary Database for hospitals of all sizes and configurations complied over 10 years

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