by Karen V. Strong
The convergence of litigation and electronic records is raising the bar on managing content from multiple systems and multiple departments. That need is introducing healthcare to the practice of managing content and records enterprise-wide.
We’ve come a long way since the days of microfilming patient and billing records. When we transitioned to document imaging systems, we saw significant productivity improvements but numerous limitations due to the lack of integration with other information systems. We imagined the day when records would be available when they were needed, where they were needed, by anyone who needed them.
Today, we have the ability to do just that and so much more. We can create state-of-the art content and records management systems that support collaboration and information sharing, comply with information privacy and access laws, establish an underlying infrastructure for integrating information systems, and support the delivery of world-class healthcare.
Enterprise content and records management (ECRM) is an emerging practice that represents the next leap for healthcare. It is much more complex than microfilming or document imaging. It addresses issues related to technology, process improvement, legal and regulatory requirements, and cultural and behavioral change. It introduces a new way of thinking about the organization’s content and records and how we manage critical enterprise information.
What Is ECRM?
ECRM is the strategy, technology, and processes for managing information assets facilitated by information technology. The term information assets is an important concept. Information, in all its forms and formats, is a vital and valuable organizational asset. Information asset management is the discipline of managing information—paper and electronic—to meet business objectives. Just like any corporate asset, information assets are created and maintained. They must also be inventoried, identified, and protected.
An organization’s information assets include documents, content, and records. Documents refer to paper as well as electronic documents. In many cases, paper documents are created from desktop applications (e.g., word-processing and spreadsheet programs) and printouts from online systems (e.g., billing applications, diagnostic applications, and patient records). In other cases, they are received from outside sources. Documents are often referred to as unstructured content. Other examples of unstructured content include e-mail, Web sites, and collaboration site content.
An organization’s information assets also include data residing in databases that are structured and can be searched based on specific database records. Structured content—or “rows and columns data”—is generally managed with information systems such as line-of-business and administrative applications.
Records are a subset of all content—structured and unstructured—that are generally governed by legal or tax record-keeping requirements. Records management is a critical component of enterprise content management. Organizations are responsible for managing all records, regardless of media, in accordance with specified records retention schedules. In addition, organizations are responsible for suspending the records retention schedule when designated records affect litigation and regulatory inquiries. Records management services are a core component of ECRM solutions and are part of an effective enterprise-wide content and records management program.
Most organizations begin their ECRM projects by focusing on unstructured content. In many cases they narrow the focus to initially address only e-mail and shared files stored on PCs, networks, and removable media. This is the content that is generally used most frequently, is the least organized and controlled, and exposes the organization to the most legal risk.
As ECRM projects progress, they expand to include additional unstructured content and eventually integrate structured content to create a single view of enterprise information and create a common platform for enterprise information asset management.
Changing Industry Terms Reflect an Evolution of Functionality
As organizations have placed increasing demand on tools to manage their enterprise information, the industry has changed to keep pace. Industry terms have evolved over the last 25 years, and they will continue to do so as technology and business processes evolve.
- EDM: electronic document management. The ability to manage documents in an electronic format expanded from the early days of scanning paper documents into imaging systems to include electronic documents at the desktop. These tools focused on the capture, indexing, storage, and management of electronic documents.
- ECM: enterprise content management. As the Internet made its introduction, organizations needed to expand the scope of information managed to include Web-based content and other “nondocument” content such as online reports. ECM tools included version control, check in/out, content-based searching, as well as Web-based user interfaces. The scope of these solutions became enterprise-wide.
- ERM: electronic records management. These solutions grew out of paper-based document/box control tools to address electronic records. The functionality of these solutions address electronic content that has been “declared” a record and must be managed throughout its life cycle according to legal, regulatory, and operational requirements.
- ECRM: enterprise content and records management. This term reflects the convergence of ECM and ERM functionality. Today’s tools must address all content, including e-mail, with full life-cycle controls and integrate retention management approaches to ensure organizational compliance. These solutions support the ability to imbed content classification, retention rules, and integrate with collaboration tools.
What may be next? The processes, tools, and the terms that describe them can be expected to stress deeper management of more information types, regardless of form. One emerging term is:
- EIM: enterprise information management. The distinction between structured and unstructured content is blurring as organizations drive to leverage enterprise search tools and methods to retrieve all relevant information to an information query. Results may include e-mail, database entries, electronic documents, and people directory entries.
The Gartner Group estimates that up to 85 percent of the information residing within most organizations is unstructured. ECRM actively manages unstructured content and offers significant organizational benefits. These benefits fall into three major categories:
Efficiency and productivity. ECRM helps ensure users have access to content that is relevant to their work, is the most recent content, and can be trusted to provide the information needed. ECRM affects all operational activities. Efficiency and productivity benefits can be realized by improving the work performance of every person and the collaboration opportunities for every team.
Governance and compliance. ECRM helps manage enterprise content as an information asset and enforces information life cycle controls, reducing the risk of information loss or legal exposure. Organizations in all industries have suffered the consequences of poor content and records management practices. High-profile law suits have demonstrated the potential damages to an organization’s reputation and the significant fines that can be levied due to improper content and records management.
The most recent revisions to the Federal Rules of Civil Procedure, which took effect in December 2006, changed discovery rules to make it easier for courts and litigating parties to manage electronic records. Electronic discovery, or “e-discovery,” refers to discovery in civil litigation that deals with information in electronic form. All information in an organization that could be relevant evidence in a law suit is discoverable. In the absence of ECRM, an organization’s ability to collect, review, and preserve electronically stored information can be onerous and costly.
Competitive advantage. ECRM positions an organization to unlock and leverage the value of its enterprise content. Organizations that have adopted ECRM as a strategic initiative have been able to create valuable processes that are not easily duplicated or imitated by companies within their industry. This may include faster time to market for new products and services, reduced costs, and improved delivery models with more flexibility to respond to market requirements.
Starting with Student Records at UT Health Science Center
The University of Texas Health Science Center at Houston educates and trains health professionals and biomedical scientists, conducts biomedical, behavioral, and population research, and provides both primary care and highly specialized medical, dental, and public healthcare and expertise.
Located in the Texas Medical Center, the university brings together the Dental Branch, the Graduate School of Biomedical Sciences, the Medical School, the School of Public Health, the School of Nursing, the School of Health Information Sciences, the UT Harris County Psychiatric Center, and the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases.
In 2002 the UT Health Science Center selected an enterprise document management and imaging system and contracted with a content integration solutions and service firm for its implementation.
Immediate Challenge, Long-term Goals
The immediate challenge was to implement an improved system to assist with the management of the student application process and migrate student records content from a legacy optical system with more than 8 million records into the new system.
Sherry A. Lyons, CRM, is the university’s records manager. Her long-term goal was to phase in a comprehensive platform that could also support other administrative functions and departments. Plans are under way to implement an electronic records management system this year.
A registrar and medical school records repository?now stores and manages documents of various types and migrates the legacy content. The system was customized to facilitate existing university application process functions and integrate with the new scanning system, the student information system, and the Texas Medical and Dental School application system to manage the process.
“We have been able to effectively phase the growth of our system from the initial implementation with applications into other departments,” Lyons says.
The shared services for imaging, document management, and ultimately records management has improved overall efficiency and accuracy, she reports, and she looks forward to extending the system into a records management system for the university.
The institution has worked to expand the system for storage of administration records as well as for accounting, human resources, contracts, research grants, and procurement records.
The Path to ECRM
ECRM programs require a strategy, supporting technology, and processes.
ECRM’s focus is the whole organization, not just one business area, department, function, or process. It requires a holistic view of organizational activities and the interdependencies of the activities as they relate to content and records management. The challenge in considering the whole organization is complexity. In order to define an ECRM strategy, it is necessary to reduce complexity by establishing smaller, more manageable projects. Organizations can begin by addressing the following two questions.
What are the information assets? What are the organization’s structured and unstructured information assets? Where are they currently stored? Who has ownership and accountability for each of them? Where is the greatest risk? What information assets have the most value to the organization?
Answering this last question requires the acknowledgment that all information does not have the same value. Some information is temporary in nature and can be deleted as soon as its purpose is served. Some information goes through multiple stages of review and revision and needs to be updated regularly to provide and maintain business value. Some information is maintained as documentation or reference material to support ongoing business activities or to comply with legal or regulatory requirements and cannot be altered. By segmenting information into categories of value, organizations can allocate resources to the management of information that offers the most value.
What are the business objectives? The organization’s priorities are a critical element in determining its ECRM strategy. Organizations can take into account their business drivers, objectives, and priorities assigned to the objectives. These may include:
- Meeting or exceeding customer expectations
- Complying with applicable legal and regulatory requirements
- Operating in a manner that is both effective and efficient
- Positioning the organization for long-term growth
The case for alignment. Information asset management is the fundamental discipline of managing information to meet business objectives. This requires aligning the information held organization-wide with the priorities of the business. Once information assets have been identified and inventoried and business objectives and priorities have been defined, the organization is in a position to define the gaps in its current environment and establish a strategy for filling them.
ECRM requires IT applications that support information life cycle management, content creation and verification, content searching and retrieval, business process management, collaboration, and integration with current applications and tools. ECRM solutions address core content and records management functions, which include:
- Capture (paper and electronic), including scanning solutions, optical character recognition solutions, as well as tools for capturing electronic content from desktop applications, e-mail, internal and external information systems, and other sources.
- Repository, including the ability to store and retrieve documents, content, and records. Repository functions are facilitated by information organization and access tools such as classification systems, taxonomies, metadata capture, information browsing/search, as well as information presentation solutions.
- Life cycle. All information has a life—it is created or received, reviewed and revised, stored and retrieved, and ultimately preserved or destroyed. The life cycle addresses information management from creation through disposition. Information life cycle management is a structured process that considers how information is classified, searched, and managed to meet operational, legal, and regulatory requirements.
ECRM solutions also address more advanced content and records management functions, which may include integration, collaboration, enterprise search, and decision support and modeling.
All areas of the business must collaborate on the design of the ECRM program. This group includes process owners and end users, legal services, compliance and auditing functions, and IT. Collaboration in the design phase helps ensure coordination in the use and protection of information assets across the enterprise.
An effective program includes a variety of technical and nontechnical elements, including:
- ECRM technology infrastructure and tools
- Governance structure
- Policies and procedures
- Guidelines for process standardization
- Information classification and retention management
- Inventories of information assets
- Training, monitoring, and reporting
ECRM can improve an organization’s ability to compete, innovate, and excel in the fast-changing healthcare industry. An effective program can improve the work performance of every person and increase the collaboration opportunities for every team.
New technology will play an important role, but technology alone is just one component. In order to succeed, organizations need to think differently about how they create and use enterprise content and records and every person’s role in its management.
Karen V. Strong (firstname.lastname@example.org) is principle of consulting company Clarity, Inc.
"Enterprise Content and Records Management"
Journal of AHIMA