In 2005, HIMSS Analytics developed the electronic medical record adoption model (EMRAM) to measure the degree to which hospitals have improved their electronic medical record systems and facilitated progress toward paperless workflows.
EMRAM measures the use of information technology applications according to eight stages, from 0 to 7, in which Stage 7 is the highest rating and indicates that a hospital has achieved excellence in electronic patient record keeping.
Ten years later, out of the more than 5,400 hospitals in the United States that the HIMSS database examines, only 3.7 percent of them had reached Stage 7 during the second quarter of 2015, and print volumes have not declined at the predicted levels. In fact, in many cases, print volumes have increased.
This surprising statistic illustrates the complex and constantly evolving challenges within healthcare, not the least of which are increased operational expenses and patient privacy concerns posed by the Health Insurance Portability and Accountability Act (HIPAA) and other security compliance regulations. Healthcare professionals need to focus their attention on delivering excellent patient care in the most efficient and effective manner, but these common challenges can make that goal harder to achieve.
In the search for effective solutions, examining your organization's approach to managing printing costs is not always at the forefront. But the reality is that the right print management strategy complements EMR adoption; improves employee printing habits; and significantly reduces costs, security risks, and IT management tasks.
The cost of printing is often overlooked
Printing is one of the higher expense categories in healthcare, yet this spending is often overlooked and unmonitored, resulting in wasteful practices and unnecessary costs. The good news is that the same software that secures enterprise print workflows can also be used for analytical purposes. Print management software monitors and reports on employee printing so it's easy to identify new opportunities to reduce waste and educate employees about best practices.
While EMR adoption certainly reduces process-related printing and helps drive workflow efficiency, people still drive a staggering amount of print, including printing for convenience — and habits are difficult to change. To maximize savings and efficiency, an effective strategy must address both process printing and convenience printing.
Our experience has shown that developing and implementing an effective, holistic print strategy yields significant measurable results and reductions in the total cost of ownership of 40 percent or more. Typical results include:
• A 35-40 percent (or more) reduction in total print volume.
• Secure and confidential documents.
• Significant reductions in expensive label-printing costs.
• System-generated reports being converted into electronic reports.
• A 30 percent reduction in toner and ink costs using centrally managed software.
• Print asset consolidation and reduction of 50 percent or more.
• Vastly improved utilization of centralized print shop assets, including equipment, labor, postage, and paper.
• Reduced color printing — often below 10 percent (color being at least three to five times more expensive than black-and-white).
• A 25-35 percent reduction in externally sourced printing costs across the entire supply chain.
Secure pull printing is quickly becoming the industry standard
Our experience within and beyond healthcare shows that designing a print strategy that incorporates secure pull printing technology enables healthcare organizations to save significantly on their total printing costs while improving security compliance.
Regarding HIPAA and printing, there are many ways to ensure documents are secured and confidential. One simple example that is often sold by printer manufacturers is called PIN printing. Users enter a PIN on their computer screen to submit a document to a particular printer, then enter that PIN again at the device to print the document.
However, employees often find this process to be inefficient, as it is a difficult touch-screen workflow and forces the user to select an individual device. Storing documents on the printer is always a concern, particularly in healthcare environments. Does it have patient information on it? What happens if that printer fails or requires service before the document is printed? A document stored on a device now becomes a security or confidentiality risk. As a result of these limitations, adoption rates for PIN printing are very low.
Secure pull printing is a far more effective solution than PIN printing. It offers greater flexibility, a simple user experience, greater risk mitigation, and an excellent return on investment. The technology sits on your existing IT infrastructure and provides secure authentication using employee ID cards. In addition to improving security and confidentiality, we typically see a reduction in employee-generated print of 20 percent or more when secure pull printing is deployed.
The secure pull printing workflow
In a secure pull printing workflow, employees print as they normally would, but rather than send documents to specific printers, employees send documents to a network queue where they're encrypted and held at rest. Whenever it's convenient, employees can then walk up to any printer and swipe or touch their ID badges to authenticate and release (or delete) their documents.
This secure workflow ensures that there is never a single point of failure. Documents can be released at any network printer. If an employee's preferred device is out of service, he or she can walk up to any other device to authenticate and print the document. This capability opens the door for reconsidering vendor SLAs and lower service costs because you have a virtual 100 percent uptime.
Printing devices are locked down — only authorized users can access them for printing, copying, and scanning. This makes it much more difficult, if not impossible, for unauthorized users to grab a document and make a quick copy, which is a growing concern given the constant visitor and guest traffic inside hospitals.
EMR integration
You can deploy a secure pull printing solution today, regardless of which EMRAM stage your organization has achieved. These solutions can be integrated with EMR systems immediately or phased in over time. Some organizations initially implement pull printing only for user-generated print, while others are fully integrating pull printing solutions with their EMR systems and beyond.
Again, it all depends on your overall strategy and state of readiness. Ideally, the entire print ecosystem would be secured. However, it's not necessary to wait for the perfect timing.
If you're not managing people, you're not managing print
Data breaches that affect HIPAA compliance can cost a healthcare organization anywhere from $10,000 to over $1 million. And the biggest risks to security are employees, whose actions sometimes inadvertently lead to the exposure of secure information. Such breaches commonly occur within printing workflows. If you don't address printing behaviors across the organization — holistically and strategically — you may not be doing enough to ensure information security and patient confidentiality.
According to a study conducted by Xerox-McAfee, 54 percent of employees claim to not always abide by the IT security policies of their companies. Moreover, 51 percent of employees with access to a printer, copier, or multifunction device in their offices admit to copying, scanning, or printing information that is classified as confidential.
Unfortunately, many healthcare organizations leave it to IT and supply chain staff to manage printing costs, usually at the device and contract pricing level only. This happens when the focus is on the printers, ink, toner, and other related supplies rather than the people who print.
Focusing only on pricing and contracts leaves a huge savings opportunity on the table. If you go after the demand side of print and strategically explore your organization's printing habits and workflows, you'll soon see how much more you can achieve toward your information security and cost reduction goals.
Discovering the best path forward
With the right technology in place to monitor your organization's printing, the analytics and reports will help to reveal the best path forward. You will be able to clarify which print workflows are actually required and which printing behaviors are based on mere habit or preference. You can start at the management level to lead by example and demonstrate to all employees that your new standards are important and apply to everyone.
As leaders in your healthcare organization working your way up the EMRAM model, ask yourselves the following questions:
• Do we have a print strategy in place that goes beyond just EMR and process printing to include all output (convenience print, copying, and faxing)?
• Do we have technology in place that enables us to monitor, report, and analyze printing down to the employee, application, and department level?
• How do I know whether I am truly maximizing my technology investments as I strive to achieve Stage 7 efficiencies?
• Are key performance measures and targets established and understood?
• Are we solving the biggest problem we can?
By improving the printing habits of your staff and utilizing technology that makes HIPAA and electronic protected health information compliance easier to achieve, you can free up significant amounts of money that can be reinvested toward your primary objective: giving patients the best care possible.
Michael O'Leary is vice president of enterprise accounts at Pharos Systems International, a print management software and solutions company based in Rochester, New York. With more than 30 years of experience in the technology and print industries, O'Leary leads an organization that provides thought leadership and expertise in software and best practices to some of the largest companies in the world.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.