The document discusses challenges faced by the mobile healthcare workforce at The Community Hospice in accessing and sharing patient information. It describes how nurses and doctors previously relied on paper files and outdated information while visiting patients across several counties. This created inefficiencies and risks to patient privacy and care quality. The document proposes implementing an electronic document management system to provide mobile access to up-to-date clinical records and policies. This would allow the workforce to streamline care delivery, better comply with regulations, and improve services for terminal patients across the region.

1. Digitizing the Mobile
Workforce: Electronic Health
Records for Hospice
George Zimmerman, Brian Lincoln
St. Peters Healthcare Services Xerox Corporation
AIIM 2011

2. The old problem – Information and
Application overload Complexity of
Healthcare
Many application areas exist
in a healthcare organization
– EHR/EMR, patient
management, health
information management,
education/training,
diagnostics, billing, etc. etc.
Hospitals typically have a
multitude of IT systems –
•Multiple EHR/EMR
Information (and paper) overload: •PACS
•Lab systems
Healthcare workers spend almost twice as much •Payroll/Finance/Scheduling
time with documents as in other industries (and •Compliance
33% of information searches are unsuccessful). •Patient Accounting
IDC, 2007 •Specialized clinical systems
– for ER, Pathology, Mental
In a 2010 survey of healthcare providers, Forrester
Health, Obstetrics, Hospice,
found over 50% of providers were still driven by
etc. etc.
paper-
paper-based processes and had not committed
processes,
to an enterprise wide EMR.

3. 2011 Technology Challenge and Driver:
‘Meaningful Use’
•Healthcare providers striving to support:
• Electronic Medical Records (EMR)
• Health Information Exchange (HIE)
• Cross-provider Electronic Health Records (EHR)
•2009 American Recovery and Reinvestment Act (ARRA),
HiTECH Act
• Accelerate EMR/EHR via incentive payments; but providers must
also show “meaningful use” of EHR, meeting a matrix of
objectives
Example ‘Meaningful Use’ requirements:
Better process capabilities
Improved patient engagement, communication
Quick patient access to records on request
Transmittal of prescriptions electronically
Cross-system coordination
Participation in HIE networks
Compliance – Strong auditing and reporting

4. And the next frontier – Going Mobile
•Use of PDA devices, tablets, Web applications has exploded
GPS, 3G, Wi-Fi, Bluetooth
all growing at over 40%
In Healthcare:
• New media tablets with better screen size and availability mean
more effective use by physicians, clinicians
• Mobile tool must match the purpose – laptops, smart phones, wireless
devices are acceptable for different clinical activities
• Security and compliance requirements are key
• Emerging mobile technologies give Healthcare providers new
options for supporting Hospice workers and other mobile teams

5. Internet Administrator/Webmaster, St. Peters Health Care Services
George Zimmerman
Senior Product Line Manager, Xerox Corporation
Brian Lincoln

6. • Who we are
• About Hospice
• Relationship to St. Peter’s
• Relationship to the area
health care community
• Special Regulations regarding
patient information

7. George Zimmerman
Internet Administrator
St. Peters Healthcare Services
Manage Internet and Web Services at
healthcare centers around Albany, NY.
St. Peter’s Hospital recently became part of the Catholic Health East
network extending along the entire eastern United States.
I have been instrumental in implementing IT solutions and policy-
setting to address regulatory guidelines related to HIPAA and JCAHO,
disaster planning, and many other healthcare-related initiatives.
I have advised and contributed best practices to many healthcare
centers across the nation.

8. • First founded by the Religious
Sisters of Mercy in 1869 as St.
Peter's Hospital, St. Peter's Health
Care Services today provides New
York's Capital Region with a
comprehensive, integrated
continuum of care.
• Hospital has 442 beds, 4,600
employees (currently merging with
two additional acute healthcare
systems).
• 25 Facilities with a wide range of
programs and services, from birth
to LTC.
• Member of Catholic Health East
(CHE).

9. • Currently expanding our Acute
care with a $250 million
expansion.
• Regional announcement to
merge with 3 upstate area
healthcare systems, making us
one of the largest in the region,
expanding to 125
facilities,1,200 beds and 12,000
employees.

10. The Community Hospice
provides expert care to
those who are very ill with
any disease, plus help and
support for their families.
We show patients and their
loved ones how to focus on
the things that matter
most, and we encourage
them to set goals and
embrace life.

11. St. Peter’s Healthcare
Services’ Web Services
group provides critical
infrastructure, network,
application, and internet
related support to help
the foundation reach its
goals.

12. The Community Hospice is a non-profit
serving 7 counties: Albany, Rensselaer,
Columbia, Greene, Schenectady, Saratoga
and Montgomery and employees
approximately 500 staff.
Of the approximately 8600 deaths last
year, 39% were receiving hospice services.
The Community Hospice set a record for
“patients under care,” caring for average
of 658 patients per day.
Approximately 64% are homecare, 33%
are residents of local nursing homes,
and about 3% are hospital patients and
receive inpatient hospice care.
Services are provided at little or no cost to
patients.
Patients often keep their current doctors,
and we work with them to ensure they are
receiving the best care possible.

13. The Health Insurance Portability and
Accountability Act of 1996 (HIPAA) Privacy
Rule
Health information technology (health IT) involves the exchange
of health information in an electronic environment. Widespread
use of health IT within the health care industry will improve the
quality of health care, prevent medical errors, reduce health care
costs, increase administrative efficiencies, decrease paperwork,
and expand access to affordable health care. It is imperative that
the privacy and security of electronic health information be
ensured as this information is maintained and transmitted
electronically.
Community Health Accreditation Program
CHAP is an independent, not-for-profit, accrediting body for
community-based health care organizations. Created in 1965,
CHAP was the first to recognize the need and value for
accreditation in community-based care. CHAP is the oldest
national, community-based accrediting body with more than
5,000 agencies currently accredited nationwide.

14. The dangers of not having document management:
• Don’t let HIPPA guidelines or JCAHO eat you up

15. St. Peters Background:
Document Management Solutions to date
Diagnosis:
Many Hospital-related documents
#1 – Key Challenges to manage and keep up to date
#2 - Benefits
New compliance, disaster recovery initiatives required information to
New compliance, disaster recovery initiatives required information to
be available, accessible anywhere anytime ::
be available, accessible anywhere anytime
HIPAA Policies (frequent versions)
HIPAA Policies (frequent versions)
Disaster/Emergency Preparedness Manual
Disaster/Emergency Preparedness Manual

16. St. Peters Background:
Document Management Solutions to date
Prescription:
Centralized management of documents
across all hospitals, clinics
Administrative /Health Policies
Nursing Generic Standards Manual
HR Personnel Policies & Forms
HIPAA, JCAHO Guidelines *
Emergency Preparedness *
Pharmacy Policies & Formulary
Document Facilities documentation
Management Hospice documentation
System IT Online Request forms
IT Customer Support
documents
Other Document Management
applications:
Integrated Faxed Prescriptions
to a secure repository
for review and fulfillment
Document Archiving

17. St. Peters Background:
Document Management Solutions to date
#1 – Key Challenges #2 – Benefits
Polices , ,Procedures and forms ––Now “Up to date”
Polices Procedures and forms Now “Up to date”
Printing cost savings ––High volume printers downsized, huge paper $$$ savings
Printing cost savings High volume printers downsized, huge paper $$$ savings
IT cost savings ––Email Inbox & Storage downsized
IT cost savings Email Inbox & Storage downsized
Trash savings and Privacy ––Less trash
Trash savings and Privacy Less trash
Quicker access to updated information ––no more binders, nurses can read and text-
Quicker access to updated information no more binders, nurses can read and text-
search Nursing Manual instantly at desktops
search Nursing Manual instantly at desktops
Employees can download HR Forms from Web --Massive reduction in printed forms
Employees can download HR Forms from Web Massive reduction in printed forms
Emergency Preparedness Manual ––readily available
Emergency Preparedness Manual readily available
Up-to-date HIPAA Guidelines are on-line
Up-to-date HIPAA Guidelines are on-line
Remote clinics and affiliates can access centralized documents from St. Peters’ intranet
Remote clinics and affiliates can access centralized documents from St. Peters’ intranet
Hospice organization can share documents with International affiliates
Hospice organization can share documents with International affiliates

18. • What Hospice does
• How services are delivered
• Administrative vs. Clinical Staff
• Overhead associated with process

19. The Community Hospice
provides round the clock
medical services to terminal
patients.
Working with the patients
directly in their homes,
Hospice provides doctor
visits, nursing care, comfort
care, and emotional support
when needed.

20. Often our nurses and
doctors will travel the 7
counties across cities
and towns to provide
services to patients.
They must being
everything needed for
care with them, as well
as be informed of the
patient’s diagnosis and
condition.

21. The Community Hospice
has both an administrative
staff and clinical staff in
order to help manage its
patients.
With patient information
spread across both the
office and the field, they
are able to provide care
seamlessly.

22. Every day the Community
Hospice deals with patient
data and the need to have
current information with
them at a site.
With a largely mobile
workforce this information
needs to be available nearly
anywhere, secured, and as
up to date as possible.

23. • Providing care remotely from
outside the facility walls
• How to access records back at the
office if needed
• Centralized Document Store
• Meaningful Use
• Security issues- the “open file on
the car seat” problem
• Disseminating information to
employees in the field

24. Paper
Land Lines
Pagers

25. Dial up Modems
File Cabinets

26. Medical Records
Storage
File Clerks

27. Incentive Program for Electronic Health
Records:
Records Issued by the Centers for
Medicare & Medicaid Services (CMS), this
final rule defines the minimum
requirements that providers must meet
through their use of certified EHR
technology in order to qualify for the
payments.
Standards and Certification Criteria for
Electronic Health Records Issued by the
Records:
Office of the National Coordinator for
Health Information Technology, this rule
identifies the standards and certification
criteria for the certification of EHR
technology,
technology so eligible professionals and
hospitals may be assured that the
systems they adopt are capable of
performing the required functions.

28. Patient Data at risk
HIPAA concerns

29. Word of Mouth
Postings
Training Manuals

30. • Transforming paper-based
process to electronic process
• Facilitating electronic document
exchange with other health care
providers and insurers
• Improves service delivery –
support/information for field
staff
• Improves productivity –
Information always available
when needed
• Easier to secure information

31. Multi-Function
Printers
DocuShare

32. HIXNY
Created through a unique collaboration
of health care providers and insurers, the
purpose of HIXNY is to mobilize medical
information for the benefit of the
patients that our member organizations
serve. By improving health care delivery
serve
in our community, HIXNY will promote
quality care and reduce costs. HIXNY
provides a secure technology
infrastructure and services to enable
physicians, hospitals, health plans, and
other health care providers to interact,
share information resources, and
conduct the business of healthcare in a
collaborative manner.

33. Tablets/Portables
Cellular/Wifi
GPS/CellTrak
Education/Training
SCCM Remote
Support

35. Point Sec
BEZ Server
VPN
Drive Encryption
Firewalls

36. • The technology chosen
• Streamlined workflows
• Reduced time required to maintain
records

37. DocuShare
All in One Printers
Blackberry PDAs
AllScripts EHR
System

38. Mileage Tracking
Automated
Maps on Demand
Voice Recognition

39. Scanning

40. • Return on Investment
• Recommendations
• Summary

41. Things you can’t
Measure
Soft cost
Availability of
information

42. Joke- slide

44. Q&A
Thank you!
George Zimmerman, IT Administrator,
St. Peters Healthcare Services
gzimmerman@stpetershealth.org
Brian Lincoln, Senior Product Line Manager,
Xerox DocuShare
brian.lincoln@xerox.com