Whitepaper paperless hospital

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This whitepaper is written by Pieter Rahusen, Clara Aguilo and Lydia Goerig Market Development
Managers Healthcare, from Ricoh Europe. This document is meant for colleagues, prospects,
customers and relations from Ricoh. This whitepaper shows Ricoh’s vision about a paperless hospital
via digitalization and management of patient/client and company records in healthcare. Ricoh’s vision
is based on years of experience with information processes in European healthcare institutions. It has
led to a modular solution that consists of several building blocks. These blocks guarantee a seamless
integration of several processes. The solution also uses the standards from existing infrastructures and
work methods.
The existing primary business and care applications, the IT environment and the work methods are
therefore the starting point for change management. Ricoh’s healthcare specialists have a broad
understanding and knowledge of the procedures and laws within healthcare. This makes Ricoh
an excellent and reliable partner that can guide and support healthcare organizations with issues
regarding a paperless office.
This whitepaper describes the building blocks of the complete solution for Smart Document
Management from Ricoh. It enables healthcare institutions to gradually switch to a paper less hospital
(step-by-step). The goal of this whitepaper is to offer objective and relevant information that supports
the decision making process about the implementation of a paperless office.

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Whitepaper paperless hospital

  1. 1. Whitepaper Paperless Hospital Offering information digitally via smart document management, digitalization and unlocking information makes healthcare institutions healthy
  2. 2. Whitepaper Paperless Hospital in Healthcare | 3 Table of content Introduction 5 1. Free market system 6 2. On-demand healthcare 7 3. Innovation 8 3.1. The New Way of Working 8 3.2. Electronic patient/client records (EPD/ECD) 9 3.3. Bring Your Own Device 11 3.4. Tablets and mobile devices 11 3.5. Smart Communication 12 3.6. e-Health 13 4. Paperless Office: Information integration 14 4.1. Smart Digitalization 14 4.2. Smart Printing 16 4.3. Smart Management 17 5. Implementation 18 6. Conclusion 20 7. Ricoh 21 8. References 22
  3. 3. 4 | Whitepaper Paperless Hospital in Healthcare This whitepaper is written by Pieter Rahusen, Clara Aguilo and Lydia Goerig Market Development Managers Healthcare, from Ricoh Europe. This document is meant for colleagues, prospects, customers and relations from Ricoh. This whitepaper shows Ricoh’s vision about a paperless hospital via digitalization and management of patient/client and company records in healthcare. Ricoh’s vision is based on years of experience with information processes in European healthcare institutions. It has led to a modular solution that consists of several building blocks. These blocks guarantee a seamless integration of several processes. The solution also uses the standards from existing infrastructures and work methods. The existing primary business and care applications, the IT environment and the work methods are therefore the starting point for change management. Ricoh’s healthcare specialists have a broad understanding and knowledge of the procedures and laws within healthcare. This makes Ricoh an excellent and reliable partner that can guide and support healthcare organizations with issues regarding a paperless office. This whitepaper describes the building blocks of the complete solution for Smart Document Management from Ricoh. It enables healthcare institutions to gradually switch to a paper less hospital (step-by-step). The goal of this whitepaper is to offer objective and relevant information that supports the decision making process about the implementation of a paperless office. Note: All references, sources and internet addresses were correct at publication of this whitepaper. The authors cannot be held responsible for changes that have occurred in the meantime. Authors Pieter Rahusen, Market Development Manager Healthcare Ricoh Netherlands Lydia Goerig, Market Development Manager Healthcare Ricoh Germany Clara Aguilo Market Development Manager Healthcare Ricoh Spain Christian Bonaccorsi, Market Development Manager Healthcare Ricoh Italia Renee Dillon, Market Development Manager Healthcare Ricoh United Kingdom Sophie Vu-Frenoy, Market Development Manager Healthcare Ricoh France Ricoh Europe November 2012 Reference
  4. 4. Whitepaper Paperless Hospital in Healthcare | 5 Introduction Healthcare institutions want to cure or care for patient/ clients quickly, comfortably and with a high quality level. That is the core competence of a hospital (Cure) or nursing and/or homecare facility (Care). The IT organization of a healthcare institution supports that mission, at the same time, healthcare institutions experience great pressure at the moment due to developments in economy, society and laws: On-demand healthcare. Cutbacks and cost savings. The quality of care should increase and be guaranteed. Interchangeability of data between healthcare institutions. Increasing demand for care and lack of medical staff. Being able to work irrespective of time and place as medical employee (mobile equipment). Patient and client (or parents) participation in the treatment process. Higher patient and client satisfaction. Attractive work environment and less work pressure. Governance, Risk & Compliance. These developments denote the importance of having information accessible in the right format, place and time in places where patients/clients and medical staff meet each other. It concerns both physical logistics, but also integration of data in an information structure system. Ricoh’s Smart Document Management aims at less use of paper in healthcare via digitalisation and guidance in this change process. It supports information processes as well as the physical treatment process of patients and clients. Digitalization of patient and client records and company data make treatments and care processes more efficient and safer. It also links medical processes to administration processes in a healthcare institution. This enables healthcare institutions to adhere to a business like approach. It saves operational costs, makes healthcare institutions more attractive on the job market and increases patient/client satisfaction. A few trends that support a paperless office in healthcare have been mentioned above. It is usually a compelling event, happening or development that forces organisations to rethink their document structure. The preconditions are different for every healthcare institution. The introduction of a paperless office strongly depends on the maturity level of an organization and the support from employees and the healthcare institution. They are the ones that will have to work and live with it. The solution is often a step-by-step introduction of the paperless office. In that way, an organization can take the first step to a paperless office whenever they want.
  5. 5. 6 | Whitepaper Paperless Hospital in Healthcare Free Market SystemChapter 1 The European population is experiencing a ‘double’ aging population. On the one hand, we have had the baby boom in the third quarter of 1945. Due to the post-war revival of the economy, the birth rates remained high for quite some time: until 1965. In the period 1946 - 1955, many children were born (the so-called baby boom).1 The first baby boomers of 1946 reached retirement in 2011. But the problem is that the next generations will also live longer. By 2050, we expect to have 1.8 billion people world wide who are over-80 years old. That is 10 percent of the population. It is clear that the economy will then be focussed around service and healthcare. This applies especially to older people that live alone and do not have a partner that can offer them support.2 The part of the population that will carry the costs for healthcare via premiums will decrease in the next couple of years. The effect is that the collective provision for old age, the pension scheme and healthcare will come under a lot pressure. The various European governments take a stand in this by stating that it may not lead to deterioration of the quality, accessibility and affordability of healthcare. In order to level the rising curve of healthcare costs as much as possible, the Market Decree Healthcare introduces many laws throughout Europe. These laws contain rules for market organization, efficiency and managed cost control in healthcare (free market system).3
  6. 6. Whitepaper Paperless Hospital in Healthcare | 7 On-demand HealthcareChapter 2 The purpose of the new law is to transform the traditional control of offerings into a free market system based on demand. Ever since, insurers and care providers are negotiating the prices and quality of care. Stronger competition between care providers stimulates them to deliver high quality care. In the new healthcare system, the patient or client is central, market stimuli play a larger role and the government withdraws more and more. When the crisis started in 2008, the views on a free market system started to change. The social trust in institutions like banks and housing corporations decreased immensely. According to the NVZ (Dutch Association of Hospitals) it is not about the regulated free market in healthcare, but about the performance affordability which enables competition on the level of quality, not on price.4 This development denotes the importance of on-demand healthcare even more. It means that parties in the healthcare sector should work together to reach high quality and efficient healthcare that meets the wishes of patients and clients. By putting the demand for care first, also means that there are more possibilities for patient participation during the treatment process. Patients/clients, but also healthcare institutions and volunteer aid want to be closely involved in treatments. They prefer to be treated at home, with machines that they can operate themselves. It will be possible in the future to counsel chronic illnesses by remote monitoring. The patient can pass on actual data themselves, like blood pressure, heart rhythm values and weight. This also applies to the prevention of disorders (Life Sciences). On-demand healthcare means that healthcare should be seen in terms of yield or benefits, not as debit or burden. Innovation is absolutely necessary in order to change this view.5
  7. 7. 8 | Whitepaper Paperless Hospital in Healthcare InnovationChapter 3 3.1. The new way of working Reaching a top position in Europe is only possible when hospitals and healthcare institutions invest in attracting more medical staff and specialists. In that process, costs must be controllable. It demands a decrease of administrative positions that support the primary process. At the same time, the population is diminishing and the demand for registering more information is increasing. The demand for care, and therefore medical staff, will increase immensely in the next decades. When the policy does not change, this will lead to severe understaffing. The problem is so serious, that the growing potential of the whole economy will be affected. According to the dutch policy advisors of the Ministry of Social Affairs and Employment, 540,000 to 750,000 additional jobs will be necessary by 2030 in order to meet the increasing demand for healthcare.11 This trend urges hospitals and healthcare institutions to start working more efficiently. More efficiency is possible thanks to technological developments like fast, wireless broadband internet connections, web based applications and early adoption of mobile equipment. You can work with a desktop computer, but also on a laptop, tablet or smartphone. Working with these technological innovations is called The New Way of Working. All the information systems mentioned under 3.2 should be always available via the internet. The New Way of Working takes place on fixed workstations, flex stations, underway, on-site in wards or rooms, from the patient’s/client’s home via several mobile devices. Although technology has made The New Way of Working possible, this is not what is causing this trend. It is caused by the request from new and future generations of employees to be able to work irrespective of place and time. Employees in nursing professions ask for a more task oriented way of working and they want to take responsibility for their own tasks. A professional should have the room and responsibility to provide care led by their own judgment. The rearrangement of tasks is one of the solutions for the capacity deficiency that healthcare is facing. Otherwise (and shorter) trained professionals will take care of routine tasks of higher educated personnel, whilst maintaining or raising the quality of care for the patient. It is important that a nurse is authorized to indicate and practice routine acts.13 Room for trust in professionals means that more time can be spent in taking care of the patient or client. It also means that less time is wasted in giving account and filling in forms. For many medical personnel, this is a much appreciated change. In “The attractiveness of the Nursing Profession” from the Nivel that has been published in 2011, nurses indicate that their profession becomes more attractive if more nurses are hired and the organization of their work changes. Hiring more nurses (75%), less administration (65%) and less work pressure (65%) make the nursing profession much more appealing. Other measures that were mentioned were more equality between the top of the organization and executives (74%), higher appreciation for the executives from management (71%) and more self-controlling teams (61%). These numbers indicate that medical staff wants their work to be organized in a way that everyone’s professionalism is expressed at its best.14
  8. 8. Whitepaper Paperless Hospital in Healthcare | 9 The New Way of Working enables people to work more efficient and be more productive. It relieves the growing administrative burden and reduces the number of errors in manual and routine work. It frees up more resources to do the actual job: providing care (or in a Dutch expression: more hands at hospital beds). The transition to The New Way of Working is not easy for everyone. Many employees have been solely responsible for a process. Now, they will also be responsible for the input, throughput and output of information in that process. It also means a change for managers: they will have to supervise more on the end result and not on the road to the end result. It is therefore very important that the introduction of a new way of working goes hand in hand with change management. Another benefit from The New Way of Working is that organisations can cut back on a number of physical workstations. Less administrative employees will be necessary, because the hardcopy information flows have been digitalized. Healthcare providers spend less time behind a desk, but more time underway, at the client’s home, in the ward or in the treatment room. At the same time, the organization has to guarantee that all employees have access to the right information at all times. 3.2. Electronic patient/client records (EPD/ECD) Information technology can be found in all corners of healthcare institutions. From diagnosis to the operating room, from diets to treatment plans. Technologies are working faster and faster, and they make fewer mistakes. Systems for processing company details and an optimal patient and client logistics make an organization efficient.7 It also enables healthcare institutions to meet the demands of healthcare these days. Healthcare that is geared towards the exact needs of the patient/client demands more than just well- equipped hospitals or public healthcare services. It requires agreements, collaboration, adjustment and direction between general and specialized healthcare institutions. Only then we can create one combined healthcare chain, where we both carry social responsibility and explicit responsibilities.8 A combined healthcare chain is not a provision, but a form of care in which several medical staff from different institutions work closely together to meet the demand of the patient/client.9 The healthcare chain encompasses the information chain between healthcare institutions and external parties as well. This is complemented by the internal information flow of e.g. management, staff departments and administration. Furthermore, vertical integrations of healthcare institutions are becoming a new trend these days (e.g. between Cure and Care). The challenge is complex due to the fact that a large part of internal and external information exchange is still on paper. The risk of double records arises due to a physical and digital record. This is inefficient and also damages the patient’s and client’s safety. Digitalization of documents so that patient and client details can be accessed by authorized people anytime and anywhere is one of the great benefits of IT in healthcare. It leads to electronic patient or client records (EPD/ECD). In Europe some good examples of efficient processes across the entire healthcare environment are findable. In Denmark for instance they use the most modern communication system. The general practitioner is responsible for the patient record. He is the central person with access to all physical examination results, radiographs and diagnosis by specialists. If a treatment by a specialist is necessary the general practitioner as a central person has to approve this first. If a prescription is needed the patient or nursing service can send a request by the electronic system to the general practitioner, who places a check mark against the required drugs, which is then delivered on demand to the drugstore via e-receipt. The patient then collects and pays for his drugs relevant to his/her treatment. Every habitant in Denmark who is paying income tax has automatically compulsory health insurance coverage. The standard and the patient satisfaction are extraordinary high. The system costs are on average in comparison to the western European countries (9,7 % by GDP).19
  9. 9. 10 | Whitepaper Paperless Hospital in Healthcare Other European countries are in progress to improve health care efficiency to reach a comprisable status. In Germany the hospitals started to implement electronic health records, partly they use it since several years. A Ricoh customer for instance uses the EPR since 13 years and does not have any paper based archives anymore. Hence the digital archive has a data volume of 4 TB. Every day 2.500 to 3.000 diagnostic findings are delivered in the system. The authenticated medical staff has an overview of all residential times by every single patient and every diagnostic findings at a glance – and this in real time and flexible by a mobile PC. The advantages are more effectiveness, cost reduction by unnecessary paper archive and improved processes, better documentation and a faster disposability and archiving across all locations. The NVZ (Dutch organisation Hospital integration) wants the Dutch hospital branch to be part of the top of Europe by 2015.6 Reaching this goal would require a structured and efficient information supply and a strong position for patients/clients. Innovation is therefore crucial for strengthening the market position of healthcare institutions. Healthcare institutions would be able to exchange information about patients/clients and their medicine use via an electronic patient or client record (EPD/ECD). Unfortunately, the law that would regulate the rules around the EPD has been rejected in April 2011. Nevertheless, the Lower House expressed the wish to use the already constructed IT infrastructure. Electronic information exchange is of vital importance for the quality of care. In 2011, the Health Care Inspectorate (IGZ) published the report “State of Healthcare 2011” about information exchange in healthcare.10 In these recommendations, IGZ calls on all parties involved to start using standardized information exchange as soon as possible, so that the chances for mistakes can be limited to an absolute minimum. The IGZ mentions 1 January 2013 as the implementation completion date. Together with the National IT Institute for Healthcare (Nictiz) and with support from the Federation of Dutch Patients and Consumers, five umbrella healthcare organizations have taken the initiative to keep maintaining and further improving the healthcare communication infrastructure (the National Link, LSP). As a part of this, the Association of Care Providers for Healthcare Communication (VZVZ) has been founded. Supervision on the private new start of the LSP is done by the CBP and IGZ. The CBP supervises the use of personal details. The IGZ supervises the delivery of safe care that healthcare institutions are obliged to deliver under the Quality Law for Healthcare Institutions and the Appeal in Individual Healthcare Law (BIG law). The LSP is used solely for regional exchange of patient details. As of 1 January 2013, patient and client details will only be exchanged if the patient/client has given the institutions permission for exchange. Patients are also able to indicate if they want their details to be exchanged on a national level. Nictiz will be responsible for the standardization of information exchange. It is therefore essential to transform hardcopy documents into a digital, enriched and standardized document form and add these to the information structure of healthcare and business processes. Source: Bain and Company: “The end of Healthcare...as we know it?”: http:// www.bain.de/en/publikationen/articles/ the-end-of-healthcare-as-we-know-it. aspx; August 2011, S. 15
  10. 10. Whitepaper Paperless Hospital in Healthcare | 11 Only then information will be available in the right form at the right moment on behalf of: Hospital information systems Client monitoring systems Business information systems Management information for the benefit of the decision making process, and Governance, Risk & Compliance Combined healthcare systems The New Way of Working E-Health applications Quality requirements 3.3. Bring your own device Thanks to The New Way of Working, a personal workstation is located in a handbag or jacket pocket. People literally carry the device (smartphone or tablet) with them. It makes people more motivated and productive, which is why it is no wonder that employers stimulate this. For many employees, it is not very practical to bring two different devices though: one for personal use and the other for business use. They prefer to work with a single device for both purposes. They also would like to choose their own type and brand of device. They prefer to buy these devices themselves as consumer. Employers are aware that adoption of The New Way of Working does not go with all sorts of limitations. They will have to meet employees in this respect with a so-called concept of Bring Your Own Device (BYOD). It implies a more flexible approach to business policy and conduct with respect to information and data security. And not to forget: the control that organizations have on devices, the applications and the data stored on it. Management will therefore find itself split between two worlds. On the one hand, management wants to show goodwill to the employees. On the other hand, management will have to comply with the regulations that have been set for Governance, Risk & Compliance. Measures need to be taken in order to combine the BYOD policy with the requirement of being in control of systems, processes and data. This situation requires solutions that support management in their pursuit to combine goodwill, security and compliance. It does not only apply to employees and those who provide care. All parties in the healthcare chain, including patients and clients, will become users of the healthcare and business system. Mobile devices are usually physically connected to a person today. Management is facing the challenge to set up a conduct and policy that applies to everyone in the organization, appropriate for the position one has and the company resources one uses. This leads to a more transparent policy and earlier adoption. 3.4. Tablets and mobile devices The forecasts for Europe are saying that the smartphones are growing at 33 % and tablets at 57 % per year. It is expected that the data traffic volume will increase by over 90 % each year. The tablet sales are driven by increasingly diversified product offerings and it will find one´s way into the business world. It is anticipated that two thirds of European companies allowed tablets on their corporate IT networks within 2012.20 It is not a strange development, because these devices offer great user-friendliness and are very mobile. Users enjoy the benefits of many useful applications thanks to apps. Tablets are slowly appearing in healthcare as well, at first mainly as replacement of hardcopies in meetings. The tablet is being used more often in the area where the medical staff and the patient/client meet each other. Thanks to the tablet, a direct interaction is possible with the information system of the healthcare institution. The practitioner can view and update the patient’s/client’s record during contact with the patient/
  11. 11. 12 | Whitepaper Paperless Hospital in Healthcare client. Digital signatures are another application that greatly benefits mobile users. Tablets can show automated form templates. With the use of smart software, these forms are transferred to tablets and the details can be filled in and processed automatically on the spot. If the user prefers a smartphone or the classical ball pen the forms can be filled in and automatically transmitted into the system, too. Other applications of tablets in healthcare are: Consultation Supervision Support at providing care Determining urgency Counselling/Instruction Remote control Material ordering Patient registration When using mobile devices in healthcare institutions, it is important that these fit in with existing systems as much as possible. Healthcare institutions also have to think about the future. Strict authentication must be possible to avoid that everyone has access to business information on the device. Data encryption enhances data security even more. The devices should also be equipped with applications that can read barcodes or create digital signatures, whilst being linked to the main system at the same time. Also important in designing a mobile architecture is to choose devices where you can add applications as you go (modular application). 3.5. Smart Communication Although technology cannot take the place of a visit to the family doctor, video conferencing are emerging as powerful components in telemedicine and telehealth initiatives worldwide. The integration of video conferencing into these programs has been able to help many patients, and has enabled doctors to communicate with specialists in order to make critical diagnoses faster. Telemedicine is the use of medical information that is exchanged from one treatment site to another via electronic communications. The term telehealth is closely related to telemedicine. It describes remote healthcare that may or may not include clinical services. Both telemedicine and telehealth may comprise videoconferencing, transmission of still images, document sharing, e-health (patient portals for example), remote monitoring of vital signs, and some of the application areas noted below. Many medical specialty areas have taken advantage of telemedicine including: dermatology, ophthalmology, mental health, cardiology and pathology to name a few. Ricoh’s Unified Communication System provides an optimal system and cloud services which can unify data such as video, voice, documents, text and handwritten input, enabling communication between patients and doctors “anytime, anywhere”. Ricoh’s UCS can help to empower the growth and evolution of telemedicine and telehealth. Some of the services that Ricoh’s UCS can enable or facilitate are: Continuing medical education for health professionals and special medication education seminars for individuals and groups in remote locations Nursing call centers for referrals and patient services Patient consultations: Audio, video, and data are shared between a patient and physician for the purpose of rendering a diagnosis and subsequent treatment plan Specialist referral services usually involve a specialist assisting a general practitioner in rendering a diagnosis. Videoconferencing enables the patient to see a specialist during a remote consultation accomplished in real-time. This is especially important for patients living in rural areas, or who are too ill to travel great distances to visit a specialist or clinic.
  12. 12. Whitepaper Paperless Hospital in Healthcare | 13 Ricoh’s Unified Communication System provides the following relevant advantages: The ability to conference with more than two people at a time. The ability to include application, desktop and document sharing in the same session in conjunction with a videoconference. And most importantly, the ability to connect virtually any patient and doctor, anytime, anywhere. This is really a combination of using P3000 UCS, Ricoh’slight-weight and portable device and using standard PCs, tablets and smartphones with Internet connections. 3.6. E-Health Before you can call on healthcare and support, people will have to make a move first. People are responsible for their own health in the first place. They can easily search and find information about relatively easy complaints (e.g. head cold). People can solve many problems by self-care. More ability to do things independently and self-management of people creates more time for the professional to provide care to patients and clients that really need it.17 The popularity of mobile devices like tablets and smartphones help the adoption of remote applications in healthcare. Patients and clients can measure their blood pressure, weight or other medical values themselves via an application that has been developed especially for that purpose. The data is automatically sent and processed via the internet. Paediatricians and public healthcare services can execute a consult via teleconferencing. It is also a real relief for volunteer aid and healthcare partners to be able to remotely check up on patients and clients. The devices, applications and technical infrastructure that will support this for health, welfare and healthcare come together in the term e-Health. E-Health can contribute to a different way of providing care. It can even (partly) replace care.
  13. 13. 14 | Whitepaper Paperless Hospital in Healthcare Paperless office: Information IntegrationChapter 4 Arranging univocal, complete and automated information is one of the most effective steps that healthcare institutions can take in order to address the issues mentioned earlier. A paperless office will only be possible with an end-to-end solution for the whole information infrastructure (from data distribution to storage and deletion). This solution also guarantees information integrity. This is possible via the application of version management and policy rules. You can control access to information via access rights based on the roles that several employees have within a company. An end-to-end solution for a paperless office consists of hardware, software and services for document and information management. Like the word indicates, an end-to-end solution for a paperless office consists of a combination of several building blocks: Setup of a smart approach for implementation Smart digitalization Smart printing Smart deployment of software, hardware and infrastructure Smart implementation Smart securing of the change process From the point of view of cost savings, it is important that this solution makes optimal use of existing infrastructures and connects seamlessly to existing business and care applications. Furthermore, the solution offers a seamless integration with healthcare information systems, which also supports the primary processes of a healthcare institution. Links to business systems for secondary processes like HR, administration or finance all run perfectly smooth. A paperless office is created by digital input, throughput and output of information and digital information management. It concerns scanning, faxing, copying, printing and storing documents. A paperless office therefore starts at a Multifunctional Printer (MFP), a device that combines the functionalities of a printer, copier, fax and scanner. This MFP supports the entire information flow. The integrated functionalities ensure that there is only one place where information on paper enters and leaves the organization. With MFPs, healthcare institutions are able to gain their first cost savings, because these machines allow consolidated printer fleets within hospitals. Fewer machines have to be purchased, managed and maintained. 4.1. Smart Digitalization The stored information in the primary healthcare system and business systems of a healthcare institution should be available online. Unfortunately, much information is still only available in hardcopies. This is usually information in the form of physical or psychological tests, but also reports about the diagnosis, the decided treatment and the progress of treatment. Referral and discharge letters and notes of conversations and findings of (former) medical employees or consulted experts are still provided on paper. Patient record archives are usually still endless rows of cabinets filled with hardcopies. Entering data on paper in digital systems is a time consuming and complex process. Simply scanning hardcopies is insufficient for integrating data into hospital and/or business information systems. The scanned information is unstructured, which makes it important to enrich scanned data with metadata. This makes the information withdrawable and searchable at a later stage. It also demands connection with a logistic system that correctly classifies, orders, routes and stores the information. It therefore requires a scanning process that consists of a combination of hardware, software and services. Smart Scanning is a good example of such a scanning process.
  14. 14. Whitepaper Paperless Hospital in Healthcare | 15 Smart Digitalization does not only make information dynamic, it also makes it possible to save documents sustainable and for a longer period of time whilst the authenticity remains demonstrable. That is what makes Smart Digitalization a practical solution to digitalizing both medical as business archives. Many hospitals have experienced the transfer from hardcopy to digital records. This was usually a one-off action performed by third parties on-site in a specialized scanning street with high volume scanners. Now that the files have been digitalized, all other files that need to be added to the record need to be digitalized and enriched. The infrastructure of these MFPs is very suitable for digitalization of these new documents. The smart scanning processes on behalf of the digitalization of hardcopies and patient records is also applicable to business documents like statements of expenses, invoices, purchasing orders and assessments of HR records. The unstructured data that has been classified by Smart Digitalization can be integrated into the (partial) hospital and business information systems. During indexation, a link is made between the document and the EPD as well. Related data from the ZIS and the business system are also linked, so that it all comes together in one record. Because the HL7 standard is applied in this process, the scanned data fills these systems seamlessly, uncompromising and automatically.16 Subsequently, the data from both sources are compared to make the data actual, accurate, correct and complete. This process eliminates duplicated, old or incorrect data from the underlying databases, which increases the value of information considerably. The right information will then be available in the right form and accessible for the right user at any time.
  15. 15. 16 | Whitepaper Paperless Hospital in Healthcare 4.2. Smart Printing Smart Scanning converts hardcopies into digital information. The software that supports this process takes care of correctly classifying and indexing of the data. This makes information throughput and storage efficient. With respect to the output of information, MFPs also offer a solution: Smart Printing. Hospitals can realize serious cost savings with this solution. Until now, many departments and individual workstations had their own printers. These machines were relatively cheap to purchase, but became expensive in maintenance and consumables due to the print quantity. These days, many hospitals question whether they still need so many print facilities. Most of the information is not printed anymore, but available via email or other applications. Information is read from computers, laptops and smartphones today. This offers an opportunity to consolidate the printer fleet. It is important though to do this with careful consideration. Printing needs to take place under the Dutch standard for Information Security NEN 7510, which is a relevant guideline for the healthcare sector. Another thing to take into consideration is the fact that in the primary healthcare process, certain standalone printers will need to stay in place due to areas where patients need to take documents with them or where barcodes need to be printed. In many other work places, in both the primary as the secondary work process, individual desktop printers can be easily replaced by one centrally located MFP. Depending on the prescribed maximum by the law or the minimum standard set by the hospital, MFPs can be placed on walking distance on strategic locations. The location can be a department, but also locations between several departments. An ideal printer fleet always consists of a combination of printers and MFPs. Many benefits can be realized by integrating these in one agreement. The machines would fall under the same Service Level Agreement and use the same reporting method for administrators. A lower number of machines also means less usage, consumption, management and maintenance costs. Savings from 10% up to 30% are common and realistic and some hospitals even save up to 50%. When reorganizing a printer fleet, it is important to start out well-prepared (accompanied by a good policy). You can look into the decisions that other hospitals have made already as a guideline and see what kind of results they realized. A supplier that has been operating within the healthcare sector for many years possesses this kind of information and can objectively advise you on the decision where to place machines and which machine types you need. The supplier can also help you set up a user right policy. The difference between printing and Smart Printing is primarily controlling and monitoring usage. If you do not monitor usage, operation costs can rise considerably due to an increase of network devices and rising output costs. In collaboration with software supplier Equitrac, Ricoh developed Equitrac Office. This application measures and manages document output on MFPs. It makes it possible to closely monitor print and copy activities. The costs are controllable thanks to easy and accurate assigning to specific persons or departments.
  16. 16. Whitepaper Paperless Hospital in Healthcare | 17 4.3. Smart Management Smart Digitalization and Smart Printing enables healthcare institutions to gain control and provide insight into scan and print behaviour, reproduction costs and information flows. Primary and secondary processes become more efficient and hospitals save loads of time and costs for management. Smart Management of printer fleets is simple thanks to integration with existing systems. All data and user rights are registered in the Active Directory (AD). The equipment communicates with the AD when employees log in with a user card or login code. In this way, they do not have to be registered twice. User rights can also be adjusted for direct output to the most efficient machine. Equitrac controls this, an application that sets up and enforces print rights and policy rules. For example, an employee should only be able to print a document when he/she is physically standing at the MFP. It can also prevent unauthorized printing and copying, or exceeding the print limits for colour output. Because the rights can be based on job position, level or even individually, document security is guaranteed. Equitrac provides insight into machine use, which enables efficient deployment of your machine fleet.18 A personal login code or access card makes user management simple, but it is also a great advantage for employees. Medical staff often works on several locations. Thanks to Follow-Me Printing, employees can make prints on a MFP of their choice. Print jobs will not get lost anymore and employees do not have to wait for their prints when a machine is in use. If all MFPs are equipped with the @Remote application that supports management, central data collection is possible. It also automatically generates and sends counter, service and consumable reports to the administrator. This information can be used for invoicing and automatic ordering of new toners. Service information is always directly available to the administrator, even when management is outsourced. This enables administrators to intervene proactively and act before problems arise, which increases the availability of the printer fleet. The MFPs are not limited to digitalizing hardcopies. Thanks to the Ricoh HotSpot Printing service, MFPs can also connect with smartphones or tablets via wireless internet. For example, you can send a print job to a MFP from any mobile device. Just like hardcopies, the purpose of the ‘print job’ can be to send data. The data is sent via a wireless connection. The employee logs into the HotSpot Printing service. It provides double security: the employee has to be authorized to gain access to a space where the MFP is located and has to have access rights to use the company network.
  17. 17. 18 | Whitepaper Paperless Hospital in Healthcare ImplementationChapter 5 This whitepaper described a few trends that stimulate a paperless office in healthcare. These trends are: the increased use of mobile devices (BYOD), the wish for more efficiency and productivity in healthcare institutions, support for employees in the healthcare chain, and The New Way of Working. These trends are all centred on the wish to access information at any place and time, whether it concerns adding or retrieving data. Information needs to be available quickly and must be easy to find. And that is difficult in a world that still evolves around physical documents. Which trend lies at the bottom of all this does not really matter, as the introduction of a paperless office largely depends on the ‘maturity level’ of an organization. Level 0 contains organizations that have no digital archives. All data is stored physically and managed occasionally. No agreements have been made about central archiving. On level 1, organizations do have a digital archive that brings sources together in a digital environment. They have made the step from hardcopy to digital document flows. That is where it ends though. No measures have been taken to unlock digital data to make it searchable. Access and user rights have not been enforced yet. Organizations on level 2 do use access and user rights, though limited. There are possibilities to work in documents and share these. Digital information has become interactive. Level 3 takes it one step further and regulates the user rights for retrieving and adding information based on roles. Organizations on level 4 have fully integrated data systems. Adding, searching, finding and managing digital information is possible within all systems and processes, irrespective of time, place or device. The reason for healthcare institutions to get off level 0 is not always a trend. Usually, a compelling event forces organizations to think about digitalization. Cutbacks may be a motivation or compliance with new laws and regulations. It may also be a wish from within an organization. The intrinsic reason will be different for every organization. Whether started by a trend or compelling event, the crux is always to take the road to a paperless office step-by-step. Only then innovation can take place, without overburdening the organization or end users with changes. This can be realized by adjusting the existing systems and processes as less as possible.
  18. 18. Whitepaper Paperless Hospital in Healthcare | 19 But which step should a healthcare institution take first? This depends on the situation. Sometimes, it is desirable to start with conversion from physical to digital information. However, it can seem pretty daunting for companies to digitalize gigantic hardcopy archives and records. Moreover, companies like healthcare institutions often have to take laws and regulations into account, like storage time. Another first step may be the design of a new, correct infrastructure. In order to facilitate optimal information accessibility in a paperless office model, existing systems and applications may need to be adjusted or renewed. New licenses, Service Level Agreements and measures for management and maintenance need to be put into place. Organizations might also run into information security issues, especially when it concerns the security of personal and patient details. How do we regulate who has access to which information, how do we guarantee integrity and how do we protect the data from cyber criminals and unauthorized people? A paperless office is not just a matter of technique. It may be the case that the first hurdle is the employees. They will want to have access to a lot of information, but how does the organization guarantee that they get only what they need, at the right moment? Can employees live with that or will they offer resistance to this new way of working? Whether it concerns information accessibility, security or behaviour, the success of a paperless office mainly depends on the policy that is employed. That is the reason that some organizations want to formulate the policy first, think about how to introduce it and how to supervise compliance. This starts with a clear insight into the definition and added value of information, though this will be different for every organization. Of course money is an issue too. Many organizations therefore ask us the question: what does it cost and what does it yield? The yield cannot always be expressed in terms of money. Satisfied employees and customers are not a debit item on a profit or loss account, though crucial for business continuity. Sometimes, the first barrier can be the simple question as to which step to take first. The developments around a paperless office are going fast and new solutions are introduced on the market each day. The technology is there, but it is about finding the right connection. This requires support from a consultant that understands healthcare institutions. Only then it is possible to make a thorough analysis of the current work processes, business and healthcare processes and targets. Based on those figures, a proposal is made to improve these processes via smart information management. The next step is to set up a collective approach with a timeline for realization. The route to change takes adoption of new work processes for employees, patients or clients into account. Afterwards, the partner can take over and continually improve management and maintenance of this environment. Healthcare institutions that already have plans, but have not yet undertaken any action, can involve experts at an early stage. For healthcare institutions that have already taken some steps, consultants can join in at any level.  
  19. 19. 20 | Whitepaper Paperless Hospital in Healthcare ConclusionChapter 6 A paperless office optimizes healthcare, makes business and healthcare processes efficient and reduces the risk of administrative mistakes. Information is always and everywhere accessible in the right form, and is based on access rights. An important condition is that information is available to users whenever and where they need it. This is an essential difference, because no matter how good information is entered and stored in systems, users should not have to search for information. This information should be present at the moment the user needs this information. The first step towards a paperless office is different for every organization. That is why it is wise to start small and enjoy quick wins. You can realize these without major changes to your existing environment. The role of the people in the change process should not be underestimated either. Help from an expert with knowledge, experience and expertise in the area of a paperless office and information management in the healthcare sector is indispensable.
  20. 20. Whitepaper Paperless Hospital in Healthcare | 21 Ricoh Ricoh distinguishes itself in the market with many years of experience and knowledge about document related issues in the healthcare sector. Ricoh’s solutions portfolio has an unrivalled flexibility and scalability. Ricoh has over 30 years of experience in consultancy, document management and output management and has built up a strong and reliable reputation in healthcare. This enables Ricoh to support healthcare institutions in changing their document input, processing and output environments. It is obvious that this document does not provide the answer to a paperless office. Experiencing it in practice is always the best. A continuous dialogue between Ricoh and its customers is therefore very important. Ricoh will introduce an online platform around the Paperless Office theme shortly. This gives everyone that has an interest in a paperless office the chance to exchange information and experiences. That is how Ricoh paves the way to a paperless office with all parties involved. Chapter 7
  21. 21. 22 | Whitepaper Paperless Hospital in Healthcare ReferencesChapter 8 1. Source: Central Bureau for Statistics (http://www.cbs.nl) 2. Source: Research ‘Baby boomers: wrinkling of a baby boom’, Central Bureau for Statistics (http:// www.cbs.nl) 3. Market Regulation Healthcare Law, Orders and Decrees 415, © Sdu Publishers, The Hague 4. The Netherlands: Top Healthcare Country - Belonging to the top of Europe. Strategic document 2010/2015, Association of Hospitals (NVZ) (http://www.nvz-ziekenhuizen.nl) 5. The Netherlands: Top Healthcare Country - Belonging to the top of Europe. Strategic document 2010/2015, Association of Hospitals (NVZ) (http://www.nvz-ziekenhuizen.nl) 6. The Netherlands: Top Healthcare Country - Belonging to the top of Europe. Strategic document 2010/2015, Association of Hospitals (NVZ) (http://www.nvz-ziekenhuizen.nl) 7. Patient and Information structures, © Ricoh Netherlands BV. Whitepaper about guaranteeing business continuity in hospitals in a free healthcare market. 8. Definition of the National Council for Public Healthcare, 1995 (later: Public health and Healthcare Council, http://www.rvz.net). 9. Association for Combined Healthcare (http://www.transmuralezorg.nl) 10. Report “State of Healthcare 2011”, a publication of the Health Care Inspectorate, October 2011 (http://www.igz.nl) 11. Report “Understaffing in healthcare”, Economic State Messages 95 (2010) 4598 p. 726 – 728 12. Labour Market Letter: Trust professionals (Schippers and others, 2011) 13. Labour Market Letter: Trust professionals (Schippers and others, 2011) 14. Report “The attractiveness of nursing professions 2011”, NIVEL 2012 (http://www.nivel.nl) 15. Source: Research “Trends in Digital Media”, executed by Intomart GfK in collaboration with Cebuco, Vinex and PMA. http://www.intomartgfk.nl 16. Labour Market Letter: Trust professionals (Schippers and others, 2011) 17. The international US Health Level 7 (HL7) organization aims to set standards for interoperability that improve healthcare, optimize work processes and stimulate a univocal policy. 18. Source: http://www.ricoh.nl/producten/output-management-en-veiligheid/s_equitrac.jsp 19. Source: Bain and Company: “The end of Healthcare...as we know it?”: http://www.bain.de/en/ publikationen/articles/the-end-of-healthcare-as-we-know-it.aspx; August 2011, Page: 15 20. Source: GSMA: http://www.gsma.com/publicpolicy/wp-content/uploads/2012/04/emofullwebfinal. pdf, 2011, Page: 2; 22

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