Cook Children’s Health Care System

The initial project

Cook Children’s is an innovative pediatric healthcare system that, according to its website, is “built on a promise to improve every child’s well-being, including their mental and emotional needs.” The health system has two hospitals, 150-plus clinics and more than 9,500 employees.

Cook Children’s went live with OnBase at its flagship hospital, Cook Children’s Medical Center in Fort Worth, Texas. The health system combined two electronic health records (EHRs) and converted 103 million documents into OnBase. The initial use for OnBase enabled four departments.

• Patient access can collect patient information from electronic forms for pre-visit workflows.
• Health information management streamlined the capture and indexing of patient medical records received via fax, email, paper scans and other sources. In addition, release of information processing was also enabled for medical records indexed within OnBase.
• Clinicians can review all of the medical records received within OnBase within their Epic electronic health record workflow for informed care decisions.
• Revenue cycle simplified the processing of patient insurance by using OnBase to decipher EDI 837 transaction strings into readable explanation of benefits that are separated by claim, so they can be indexed to the right patient.

The result was “more efficient processes around all of these documents that are coming in,” said Randy Powledge, Cook Children’s manager of enterprise content.

Departmental expansion

A couple years after the initial launch, the health system found new ways to utilize Hyland’s intelligent content solutions to expand value across the enterprise.

Accounts payable (AP) and finance

Cook Children’s receives invoices in a variety of formats — including email, snail mail and faxes. The health system utilizes Brainware, Hyland’s advanced intelligent capture software, to read and extract data from the invoices, and Hyland’s Workday integration helps Cook Children’s automate its AP processes.

Reporting dashboards track performance and provide real-time views of potential bottlenecks.

“If there’s something that’s slowing the system down, we might be able to address it in these processes,” Powledge said. “The dashboards have been really helpful.”

Contract management

Cook Children’s used to track contracts via paper, Microsoft Excel spreadsheets and other applications. Working with Hyland Services, the health system built custom workflows for contract approvals, modifications and revisions, and to obtain signatures and archive the agreements.

WorkView — a low-code, configurable framework that is natively integrated with OnBase Workflow and allows users to create custom applications — provides the flexibility that a large health system requires.

“If the vendor doesn’t want to get the contract via DocuSign, you can export the document, send it through email and they can go through whatever process they want to, send us back the document, and we just put it right back in the system. And it’ll create a new version of that document,” Powledge said.

The Cook Children’s enterprise content manager likened the health system’s WorkView workflow to tracking a mobile pizza order. There are icons across the top of the contract that show each step in the process — from the completion of the review to the expiration of the agreement and the deal being archived. Time stamps show when each part of the process was completed.

Enterprise imaging

Cook Children’s wanted an enterprise imaging platform that seamlessly integrated with Epic, provided image sharing collaboration and gave patients the ability to access and share images. The health system thoroughly evaluated vendors before selecting Hyland.

“Hyland being a strong partner with Epic is why we decided to go down this path,” Powledge said.

The first phase of the project was rolling out NilRead, Hyland’s robust universal diagnostic viewer, to provide fast access to radiology and cardiology images within the EHR.

“This allows for transparency across the whole enterprise,” Powledge said. “We’re trying to get the information into everyone’s hands and be able to make those decisions as quickly as possible.”

Next up will be providing NilRead access within Epic’s MyChart, followed by utilizing Hyland Clinician Window for point-of-care imaging workflows in multispecialty departments.

Home health

Cook Children’s created admission packets with WorkView, which proved to be especially important during the COVID-19 pandemic. The streamlined process helped home health specialists structure a set of documents that were catered to each patient’s needs and get real-time patient information.

This improved the home care experience and “ended up being a huge win” for the health system, Powledge said.

HR

With an assist from Hyland’s HR solution, Cook Children’s has automated the employee content life cycle. Hyland’s end-to-end solution manages content at every point of the journey, accelerating decision-making and improving employee productivity.

Medical record annotations

Having the necessary parties present for signatures was an issue, especially with physicians supporting three or four clinics. To solve the problem, Cook Children’s built a custom solution with OnBase Workflow that allows physicians to electronically sign documents that require annotation.

“This was very easy for the doctors to use,” Powledge said. “It allows them to sign this and review it wherever they’re at. It’s a huge patient satisfaction thing as well, because if a referral is needed and that provider is out of the office, they’re able to view that document in order to sign it and get it back into the system so other actions can take place.”

What’s next?

Cook Children’s plans to do a lot more with Hyland. Future initiatives include using Brainware to automate and simplify the indexing of medical records, and speed the referral process. The health system also wants to create vendor scorecards with WorkView.

How much does a contract actually cost over the long run? How accurate is a vendor’s billing? How does the vendor perform relative to others? Those are questions Cook Children’s is hoping to answer with the creation of vendor scorecards.

Hyland is so prevalent within the health system that Cook Children’s has nine OnBase administrators — a group that’s split between development and administrative teams.

The health system was looking for “a place to store documents.” The impact, though, has been far more impactful. Cook Children’s team of innovators have used Hyland technology to intelligently connect content, images, core systems and processes to power workflow and outcomes enterprise-wide.