The Differences Between Document Imaging, Document Management, Practice Management, EMRs

In my past columns, I have discussed compelling reasons for moving your clinic toward a “paperless” environment (see Figure 1). In this article, I will discuss the differences for certain classes of software systems that can make a paperless clinic a reality. Such software systems include document imaging, document management, practice management (management and billing), and EMR (electronic medical record system). Most clinics either already have billing/practice management systems or outsource this function. This is usually one of the first steps in computerizing your clinic and considered to be the front office component. This article will focus on the more difficult clinical aspects: dealing with patient encounter information, the generation and management of information—both within the clinic and coming from outside sources.

Knowing a system’s capabilities is a major point of contention because many of you, wanting to become “paperless,” are then sold software without knowing what office functions it will computerize. For example, some doctors buy document imaging and expect an EMR, while some buy an EMR and expect document imaging. Others buy billing systems that offer billing but do not offer practice management or an EMR. Thus many doctors become unhappy because the purchased system falls short of their expectations. Here are a few of the issues to understand:

1. Document imaging does not generate reports/notes.
2. Document images of your handwritten and paper files are just pictures/images of the same.
3. Information that comes from extraneous sources—received through a fax, email or mail—have to be organized “electronically.” In other words, if these documents are scanned, they end up being images that have to be electronically organized.
4. Images are pictures and are not considered “data.” In order for a picture of a report to be turned into data, there is a process called Optical Character Recognition (OCR) that converts images to textual data. However, unless the picture is clean and crisp (devoid of marks/imperfection), there is a chance that there will be an incorrect conversion to data (wrong letters/words/sentences/errors, etc.)
5. Images take up more space than data-driven EMR software so computer infrastructure (memory, speed, security, etc.) become important decisions that have to be planned and implemented correctly.
6. An EMR generally refers to information/data that is generated within your clinic regarding pertinent pain-specific reports/notes. Older archive notes cannot and/or should not be re-input into an EMR for many reasons. Entering old data can, and will, get you behind in entering your current files into the EMR and could keep you from successful implementation.
7. “Best of breed” software (e.g. pain management EMRs, practice management systems that offer pain specific billing, etc.) do not often come from the same company and so interfaces need to be created (refer to my interoperability series of articles in Nov/Dec 2006 thru March 2007 issues of this journal).

You need to become knowledgeable in order to know what is important in your conversion to a paperless office. Setting your priorities incorrectly could cause you to invest in the wrong technologies at the wrong time and not get you what you need. Of course, what you really need is everything in one software product and, in a perfect world, you would get a great document imaging/management system having a pain management-specific EMR system, together with practice management—at reasonable cost. There will be companies that will try to tell you that they have it all but, realistically, there is currently not a system on the market that offers it all. And yes, some of you will make the mistake of hearing what you want to hear and buy the wrong system—even after reading this. While there are no systems out there that offer it all, there are good systems currently available that can be interfaced to help you now.

Figure 1. Inefficiencies of clinical paper information processes.

I believe that in the next few years there will continue to be better systems that offer much of what you need to organize all your files electronically. I also believe that software interfacing will continue to evolve so you will be able to purchase “best of breed” software systems and have them link more seamlessly in the future. Many hospitals are currently doing this by interfacing systems that best fit their departmental needs.

Terminology

In order to understand the technical terms of some of these classes of systems, it is important to understand what each does and why. Some key concepts include:

• Practice Management
• Document Imaging
• Document Management
• Electronic Medical Records (EMRs)

Practice Management

These are, primarily, billing systems that allow appointment scheduling, insurance, patient demographic data, financial management, reminders, electronic billing, etc. Billing is, of course, necessary in order to allow you to receive payment for your services. Most billing systems offer various levels of practice management. Practice management allows you to review and analyze patient and practice financial statistics. A billing practice management system is a big step towards becoming paperless, however it is only part of a big puzzle—the front office part of your practice. The back office that, for simplicity’s sake, I will term “clinical,” is the more complicated and dynamic part of your clinic. And the part that generates and necessitates the management of a lot more paper than is generated in your front office.

Document Imaging

Imaging is a crucial step to becoming paperless and, without it, you cannot become paperless. Simply speaking, document imaging is capturing any paper document into an electronic image. That is, taking documents that are generated within your clinic or received from external sources, scanning and turning it into a “picture” image of that paper.