Today I met with a multi-disciplinary group at BIDMC that is rethinking traditional academic medical center office space and is planning the office space of the future with innovations such as shared open floor plan workspaces, "huddle rooms" for ad hoc meetings, shared IT infrastructure, easy to use wall mounted displays, electronic conference room availability indicators, and ubiquitous use of scanners to eliminate paper.
Like many academic medical centers, BIDMC has a high demand for closed door offices but has a limited supply of real estate. Most clinicians are in the their office less than 10% of the time, so conventional approaches to academic departmental space are very inefficient.
Today's meeting focused on work flow. How is clinical and administrative paperwork eliminated in a shared office space environment? Who does scanning/metadata tagging/quality control of scanned documents? What regulatory/compliance issues need to be addressed as paper filing cabinets are turned into electronic folder systems?
Clinical scanning is easy - we already have a comprehensive approach that uses high speed scanners, Captiva software, and an automated upload directly into our medical record.
Administrative scanning is harder - we have not implemented a document management system such as Documentum. I welcome advice from my readers - how you eliminated administrative paper storage with scanning? What are your retention and security policies? How do you query and retrieve selected documents?
Since there are no closed door offices in the new design, several small "huddle areas" enable ad hoc private meetings with automated electronic display of room availability and appropriate wall mounted LCDs supporting presentations from laptops and iPads.
Finally, since new data will be entered electronically and not on paper, we've deployed eScription voice recognition software in our data center. Clinicians can use a phone or an iPad/iPhone app to upload voice files for immediate voice recognition and insertion into our electronic record.
There will be many lessons learned from this office space of the future. Hopefully we'll offer a very attractive space with high productivity in a smaller real estate footprint that is used efficiently More to come as we go live.
One of the better products out there is Microsoft SharePoint. I used it when I was going to school and it had a bit of a learning curve, but the newer versions are much more intuitive. SharePoint can REALLY make a difference for data storage and file sharing over a large network. For example; Many large universities use it and I believe the USAF uses some version of it as well.
ReplyDeleteIt has a pretty extensive query tool, but I'm not 100% certain on whether it meets compliance standards. I know it can be used as the backbone for an ISO9001 certification, and meets DOD because of the USAF contract, so that should be good enough.
Thanks for your posts Dr. Halamka.
ReplyDeleteI work at Children’s so we feel your same pain of physical space constraints. We are Sharepoint users here. We also have an internal social networking collaboration site for our employees. Its called SPARC - the Social Platform for Accelerating Resources and Connections. It is our attempt to create a “virtual water cooler.”
I read a Harvard Bus Review article http://hbr.org/2011/07/who-moved-my-cube/ar/1 about the future of office space. Interestingly, creating an open working environment designed to promote innovation and collaboration actually had the opposite effect for the company discussed in the article.
I’m very interested to read more about what your committee comes up with.
I would like to hear more about how you put eScription text documents into your EHR sections. Does staff decide where the text is inserted or is it done by "section identifier. We struggle with that issue.
ReplyDeleteOpenText offers such solutions - typically "libraries" are organized for departments that enable them to store content unique to them with access privileges managed by the department. These libraries do NOT contain medical records, but rather other content they desire to retain, share, edit, revise etc. One prominent user is Geisinger - they've implemented libraries that span from clinical science to research, all leveraging the same IT infrastructure, implementing a common, automated retention policy, and supported with the same staff that supports the medical record.
ReplyDeleteOn a related topic, I looked at your 2008 post relating to scanning and at the image you had posted and chuckled (http://geekdoctor.blogspot.com/2008/02/scanning-technologies.html) we provide a very similar, chart-based UI that doctors find intuitive. They know what content to find under which colored tab.