Complex healthcare IT projects like EHR implementations, ICD-10 migration, and related IT initiatives require sophisticated change management practices and policies. Given the people-centric nature of policy development, those of us in IT usually assume that change and policy management can’t be automated, usually to our detriment. To help understand how that’s not quite correct, I reached out to the developers of PolicyStat, which provides policy and procedure software for hospitals, labs, outpatient clinics and integrated health networks. I asked them to help explain what “policy and practice software” is, why it’s useful, and what the options are. Here’s what they said:
Manual, repetitive, time-consuming processes in information management have somehow survived in many healthcare organizations through 2011. Behind-the-times hospitals are using three-ring binders to store their hundreds or thousands of policies, procedures, guidelines, protocols and checklists – all of which must be reviewed and approved on a regular basis in keeping with compliance. Information that should guide the care given to patients is not even consulted in many cases, either because the staff member cannot find a particular policy or because he or she does care that it exists. Hospital administrators and others at the top might care about the problem, but they “have bigger fish to fry” in the health IT world in dealing with EHRs and other more popular IT systems. Systems for managing these policies, procedures, guidelines, protocols and checklists fall to the bottom of the list.
EHRs are a hot topic now, and they should be. Healthcare is taking drastic turns, and it’s not possible to fix every problem at once. But just how big of a deal are policies and procedures? To understand the magnitude of policy and procedure management, take a look at two examples below of facilities – one large, one small – which have already implemented a policy management system (please note that “policies” also includes procedures, guidelines, protocols, etc).
Large short term acute care facility with 1,000+ beds
5,198 active policies which must go through annual approvals
2.08 average approval steps per policy (ranging from 1 – 4 steps)
4.38 average days per step (ranging from 1 – 258 days)
3,763 – 10,961 monthly policy searches (data below are monthly averages from October 2010-11)
Small critical access hospital with 25 beds
1,450 active policies which must go through annual approvals
3.27 average approval steps per policy(ranging from 2 – 4 steps)
15.8 average days per step (ranging from 2 – 23 steps)
0 – 238 monthly policy searches (data below are monthly averages from October 2010-11)
If you do the math, the large hospital goes through an overwhelming 10,812 approval steps per year, with each step lasting more than four days. The small facility goes through 4,742 approval steps per year at an average of almost 16 days per step. Considering the time it takes for an approver to search for the document requiring approval, make changes and email it to the next person, it is obvious why manual policy approvals are so time consuming. Furthermore, it takes substantial time for a caregiver to search for and locate the needed policy or procedure while also attending to patients.
A policy management system helps a hospital or healthcare facility in two ways: it reduces manual processes such as policy approval routing, and it helps caregivers quickly and efficiently find and consult information. By using powerful software to manage your 1,000+ policies and procedures, your hospital can save money and provide the best patient care possible.
Let’s assume you have decided to implement a policy management system for your organization. Maybe the person in charge of policies has run into problems with compliance and needs a better system to track expirations. Maybe your administration has been flagged about the major inefficiency of the current process. Or perhaps you have an EHR in place already and want to start your next tech advancement. Whatever the reason, you will want to explore your options first.
Types of Policy Management Systems
There are three main types of systems available to you, each of which requires different levels of IT involvement: a legacy document management system, a hybrid document management system and a web-based content management system.
Legacy Document Management
Description: Lack of system; shared drive/intranet which stores native files such as Word or PDF
Pros: Infrastructure already exists, so IT staff resources are not required for development; does not require hardware or software (besides MS Word); users are familiar with using shared drives.
Cons: Versioning of documents and workflows are manual; lacks audit trail; lacks full-text searching; lacks visibility into expirations on policies; makes sharing/coordinating across facilities difficult; makes it hard to standardize documents; requires users to download documents to MS Word to view and edit.
Tips for implementing (or restructuring) a legacy document management system:
- Create clear ownership responsibilities around departments.
- Define standard approval workflows and folder structure.
- Define and enforce consistent naming conventions which include author, date and policy area.
- Back up older versions but store them away from the typical users’ view.
Hybrid Document Management
Pros: Facilitates defined workflows; automates workflow routing; sends reminders for expiration; keeps track of an audit trail; makes searching easier; allows for security and access control.
Cons: Requires set-up and training; lacks context-sensitive searching; makes sharing/coordinating across facilities difficult; makes it hard to standardize documents; requires users to download documents to MS Word to view and edit.
Tips for implementing a hybrid document management system:
- Ask individual department owners to organize their policies before implementation.
- Agree on and create a standard document template.
- Use naming conventions to make searching as intuitive as possible.
- Push as much interaction into the system as possible.
Web-Based Content Management
Description: Completely web-based application with no software/hardware or plugin to install
Pros: Allows for editing/collaborating within the browser; returns relevant search results almost instantly; does not require software or hardware; available from mobile devices and from home; lets system admins make site-wide changes at once; enables sharing/coordinating across facilities.
Cons: Requires upfront implementation and training; requires initial research to find the most cost-effective system.
Tips for implementing a web-based content management system:
- Standardizing your entire policy library can be a considerable task if you are not organized. Find out how much of the workload falls on your organization before choosing a system/provider.
- Review system status regularly (how many policies are expired).
- Encourage ubiquitous access (mobile devices).
- Take advantage of all features, i.e. use notifications feature instead of emailing.
- De-centralize workload for approvals and policy revisions by assigning owners to policy areas.
Restructuring or implementing a new policy management system requires some effort from all departments – IT, nursing, infection control, compliance, risk, etc. Make sure your authors, editors and approvers are all on board before making a decision. You might be surprised by their level of enthusiasm for getting a better system in place.