1 Optimized Policies and Procedures in Healthcare with Oracle WebCenter Content GEORGE SOKOL & JENNIFER MARZOLF FISHBOWL SOLUTIONS, INC. i
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3 Contents 1 Introduction Executive Overview 1 2 Key Challenges Many Products, Few Solutions 2 3 Oracle WebCenter Content Core Document Management Functions 3 4 Enhanced Content Delivery 6 5 Pulling it All Together 7 6 The Enhanced Solution Customer Case Study Primary Healthcare Provider 10 7 Summary 11
5 1 Introduction Executive Overview The management and execution of a policies and procedures is a challenge facing all organizations both large and small. With the advent of increased regulatory compliance through industry (see JCAHO) and government (see HIPAA and ARRA), the complexities and oversight needed are particularly hard felt within the healthcare industry. The resulting array of solutions brought by technology vendors typically hit one area expertly while often falling short in other areas. For example, while some may handle the technical editing challenge they tend to fall down in terms of collaboration or distribution of information. While others that do well on the collaboration end (see SharePoint) often fall down in the areas of auditing and compliance. Fortunately, Oracle s WebCenter Content has a long history of being used to not only manage and control the review of policies and procedures it excels in flexibility and distribution of this information to whomever needs it, when they need it, and in the format they need it. This whitepaper covers the key out-of-the-box features of Oracle WebCenter Content as it relates to this issue as well as providing an overview of the Fishbowl Solutions add-on product, Policy and Procedure Suite, for extending WebCenter Content for more rigorous compliance or needs.
6 2 Key Challenges The key challenges of maintaining a policy and procedure system for healthcare share in some important ways requirements necessary for any organization that must follow government mandated policy and procedure management. Organizations falling under this umbrella include manufacturers, food processors and growers, scientific and university research, as well as pharmaceutical and engineering organizations. In fact, in many cases, there are many organizations in the world that traverse two or more of these disciplines and yet maintain tight control over the policies and procedures of each of them. Some of these key challenges include: An easy to use, intuitive authoring experience Complex document hierarchy and structure Tightly integrated workflow review Support for periodic reviews Auditing of key user functions Compliance with records management initiatives Portability of document format Automatic distribution of information Automatic notifications for new content 2.1 Many Products, Few Solutions Organizations have tackled this problem with everything possible. From expensive complex compound document products specifically tailored for policy and procedure management to simple collaboration systems to shared drives. Each has its pluses and minuses but few are comprehensive enough to fill the gap between authoring, viewing, review, and distribution of the final product easily across multiple delivery channels including web, print, and mobile. 3 Oracle WebCenter Content Oracle WebCenter Content is Oracle s market leading enterprise content management solution. It consists of three primary components: Imaging and Process Management (aka IPM, providing a imaging and process management solution for Oracle application customers), Universal Records Management (aka URM, which is a DoD certified records management system for both physical and electronic records), and Universal Content Management (aka UCM, and which is the basis of the other two components and provides the core enterprise content management repository). For the purposes of this whitepaper, unless explicitly stated, we use the term WebCenter Content and Universal Content Management
7 interchangeably to mean the same thing as UCM is the primary component of the solution outlined in this document. Oracle WebCenter Content has a number of out-of-the-box features, functionality, and existing customer deployments to support its selection as a solution to advanced policy and procedure management. Unlike niche or repository centric solutions, the product excels as a candidate for policy and procedure management because from its earliest days when it was known as IntraDoc! or Stellent, the architecture was designed with both core document management centric features (such as check-in/check-out, version control, and workflow) and consumption of information as equally important. This critical distinction relates to the very nature of policy and procedures and that is to inform, instruct, and authorize employees on how to go about doing their jobs while complying with various organizational quality controls and legal mandates. A system that locks information within a single method of accessing or that is author centric (in contrast to the consumer of the information) is antithetical to the very nature of these goals. Though organization guidelines may reinforce the need to read and review these procedures, the value of this information is only as good as how easy and simple it is to access by the end user. 3.1 Core Document Management Functions As outlined, a big part of policy and procedure management often involves document management. Oracle WebCenter, which having entered the market in 1996, was possibly the world s first commercially available 100% web based document management system, supports key document management functions within its core. Check-In / Auditing of the changes and authorship of policies and procedures is a Check-Out critical component of compliance tracking as well as preventing out-oforder changes to content. Oracle WebCenter Content forces users to check-out files before they are allowed to make changes and then locks the record from changes from any other user until the current editor has checked their changes into the system. Version Control The version control of WebCenter Content is automatic and configurable. Users are never provided direct access to a checked-in file but only a copy. And the edits a user makes to that copy can be forced at the system level to always result in a new version. Additionally, the system supports both major and minor labeling and in a fairly unique twist even allows organizations to control the format of how that labeling is applied. Metadata / WebCenter Content comes with a simple document taxonomy as well Tagging as utilities to extend its metadata library with an unlimited number of fields. Users are allowed to tag and categorize content using free form text fields, validated selection lists, date and number fields, user modifiable selection lists, lookup fields, and other common metadata tagging options. Support for Dublin Core and other taxonomy models can easily be added and configured using the administration tools of the system.
8 The system can support the application of tagging in many ways ranging from forced prompting of metadata to the end user to the automatic application of field values on a record based on the user and how the content they are adding to the system. Finally, fairly unique to WebCenter Content, is the ability to keep records of metadata at the version level of the content item. This allows reviewers and authorized users not only to view what was applied to the last released version of content but also to view a historical records of attributes and data applied to the content for all versions maintained by the system. Search Powerful search features enable users to do full text searches, metadata searches, or any combination of the two. Oracle WebCenter Content comes with both Database Text searching (the default) as well as a limited use license of Oracle s Secure Enterprise Search. Searches can also be saved (saving valuable time when working on a particular grouping of procedures) and even shared (via copying the URL) with other users of the system. Security WebCenter Content has one of the most configurable security models of any content management system. The system may be configured to secure content based on user role, directory hierarchies, as well as Access Control Lists (ACLs). The role based security is the most commonly used as well as extremely powerful as it can provide access to users dynamically over time based on the role of the user as opposed to the individual application of a security setting to a file (which is how most other systems work). This greatly reduces the administrative overhead of maintaining a policy and management system over time and can be superior to ACLs. Document All content added to the system feature a unique and dynamic numeric Numbering value assigned to them which follows the document through its entire life cycle. This feature can be configured for a specific format and the system supports user defined fields for this value as well. Application WebCenter Content is ideal as a 100% web based content Integration management requiring no client software, no software integration. At the same time, it can support both simple drag and drop functionality on the user s desktop (using WebDAV) as well as enhanced application integration with Microsoft Office with the included Desktop Integration Suite Client. The Desktop Integration Suite provides tight Office 2010 integration support including a ribbon command bar, folder integration with Microsoft Outlook, and enhanced menu operations. It also enables user to view and modify (if they have rights) the metadata of content directly from within Microsoft Explorer.
9 Auditing & Automatic and out-of-the-box auditing includes the tracking of all Reporting changes to content as well as the content s release and publication. Additional parameters may be turned on (such as the Retention Management or Universal Records Management modules) that provide additional in-depth history of both content and metadata changes. Additionally, through the core repository engine as well as through the records management options, the system includes dozens of pre-built reports which can be customized and tailored and even checked-in back to the content management system to provide a historical log of activities throughout the systems operation. Records The system includes not only one but two options for performing Management records management. The Universal Records Management component of WebCenter Content provides a complete Department of Defense certified records management solution to managing policies and procedures (and other content) for those that need it. While the Retention Management component of the core repository engine does very nicely for those organizations not needing the rigor of DoD standards. Workflow Review Workflow is part of the core engine and native. Workflow options support both simple and complex, parallel or serial, ad hoc or highly structured workflows. A limited use license of Oracle s BPEL Manager is even included for those organizations pulling and exchanging information with other legacy systems. Periodic Review As part of the workflow implementation, Oracle also offers a periodical review workflow that can be configured to trigger at specific time frames prior to the expiration of content. These review workflows can also be in support of a formal records management process. Multiple A critical component of structuring policies and procedures for viewing Document (as well as for accelerating checklists for editing) is the ability to Hierarchy present these items in a logical well structured order. WebCenter Content offers multiple ways of performing this tasks through features such as Contribution Folders (the ability to create and maintain content in a folder/directory like structure) as well as Library Folders (which are a dynamic hierarchy maintained through document queries). Persistent URL The concept of the Persistent URL present in WebCenter Content is present throughout the system. This concept pertains to the system ability to provide access to the latest released version of a content item regardless of when or how a user accesses the URL. This ensures that even when a policy content item is linked externally (say from the browser Favorites or from a hyperlink in a Word document), clicking on the link will always display the latest released approved version of content and not the file as it existed when the link was first created. These makes it easy to create valid lists of content and not have to continually manage links and ensures users always see the correct version.
10 Automatic PDF WebCenter Content s Conversion Server component can be enabled to Creation automatically create thumbnails and PDF copies of content and associate these with the items directly. Referred to as the Web Viewable format, these PDF files become the default version opened when clicking on a link from a search results list. 4 Enhanced Content Delivery As described earlier, however, a core feature often missing from similar systems is adequate content delivery mechanisms to provide access to policies and procedures to the users who actually need to read and follow them. For this purpose, WebCenter Content offers the following features. Web Content Management (Site Studio) Skinning and Layouts Site Studio is a web content management component of WebCenter Content that allows organizations to take their content collections and provide access to this information as web content. It not only supports publishing the typical native (i.e. post a link to the Word file) and PDF but perhaps most useful is the ability to push native content such as Microsoft Word and other Office files as properly formatted HTML! Enhancing this is the ability to also produce navigation based upon metadata so that users can now navigate through an entire collection of policies and procedures as if the information was created specifically for a web site. This feature effectively creates a consumption view of the content separate from the authoring experience you would see in the native WebCenter Content user interface. There are no limits to how the site appears within the browser and organizations will often use this feature to make their content collections appear as an extension to their existing web site presence. Finally, the very look and feel of the WebCenter Content user interface itself can be re-skinned with the organization s desired look and feel as is often done for what are called Consumption Servers. A Consumption Server is simply another instance of WebCenter Content to which content is pushed from an internal WebCenter Content instance (often referred to as the Contribution Server). This is a traditional architecture for Site Studio but is also effective when organizations want to simply make their existing content available through a web site and yet take advantage of all the core features of WebCenter Content on the web. It should be noted that the latter method has fallen out of favor by Oracle somewhat in the last several years but that s a shame. In many ways it is easier to deploy and easier to support than other options for this purpose. For one thing, you can more readily embed enhanced document management features into the web site without having to build custom components and this is a huge advantage over many competitive offering. The most likely reason this has fallen out of favor can be probably attached to simple loss of tribal knowledge!
11 Another very powerful tool that was part of the original Stellent purchase by Oracle was Content Publisher. Content Publisher was Stellent s original web content management solution and as such left much to be desired. But it was fantastic as a publishing tool for document collections such as Policies and Procedures, particularly when you needed to produce CD- ROM versions of a collection. Today, to do something similar involves using Site Studio Publishing Utility or SSPU which is not as user friendly but can be used to get the job done. 5 Pulling it All Together Now that we ve looked at the various features available to support building out a Policy and Procedure management application, let s look at some simple recommendations for tying it all together. The following assumes you have a working copy of WebCenter Content s Universal Content Management server properly installed and running with a basic configuration. It doesn t take into consideration any complexities or customizations you may want done but it does offer a good way to step through a basic implementation of the software for this purpose. 1. Start by creating a simple folder hierarchy in the Contribution Folders interface of UCM. For smaller organizations, such as structure might be as simple as organizing policies under folders such as Admittance, Employment, Patient Care. For larger organizations, a location approach such as the following might be followed: a. Templates b. Organizational c. Cleveland Facility i. Admittance ii. Privacy iii. Etc d. San Diego Facility i. Admittance ii. Privacy iii. Etc 2. If you haven t already, it is a good idea to setup an instance of Conversion Server to create thumbnails and PDF renditions of all your new policies and procedures. This will not only provide you with a portable document format that is independent of the content you ll be storing but will also aid in reducing network bandwidth issues (think SharePoint and having to open all those Office files!). 3. Check-in all of your existing Policy and Procedure templates into the folder \1. Templates. A nice handy trick is to save these as Office templates (if using Office). This
12 way a user can either save directly back into the repository using these files on WebDAV or simply have a nice handy way to store templates on the server. 4. Next, design your strategy around metadata. This may be as simple as simply adding a Document Type to UCM called Policy or Procedure but it may extend to designing multiple fields and even creating a new Profile called Policy&Procedure. 5. Next, design your security. The simplest would be to create some simple groups such as policy_authors and policy_readers and then lumping everyone into these two roles to control who could read and who could edit new guidelines. For most organizations, we see either an enhanced accounts security structure or even an ACL based security mode as the most applicable. This is because very often for large organizations one location will not be allowed to edit or even see another location s documents. This will depend upon your organization. 6. Start creating and importing some sample policies and procedures, according to the folder structure you ve laid out and the metadata and security design you ve created. 7. Next look at workflow review. Start by trying to map out the different reviews needed in your organization. One method we ve found very successful at a lot of organizations is that rather than try to map out every conceivable workflow scenario we often will create an ad hoc workflow that assigns simple review and approve steps based upon users and groups specified by the author on the metadata at the time of entry. 8. You ll then want to look at what type, if any, periodic reviews are necessary. For this purpose, you ll want to look at the Oracle NotificationOfExpiry component which can trigger an annual review based upon the Expiration Date field. Or possibly even explore integrating Universal Records Management and using its review/workflow options. 9. Next, test the system. Once you re happy with the metadata, security, and workflow, it s time to import the rest of your policy and procedure content. 10. Finally, consider how you want the consumers of information to have access to your content. For highly technical people, simply providing read-only access to the content and structure you ve just laid down may be fine enough. But for busy healthcare workers, and possibly patients or consumers you ll want to look at using one of the web content management options discussed previously. 6 The Enhanced Solution If you re familiar with the Oracle WebCenter Content product and followed along with the steps in the last section, by now you might be saying so far, so good. And many organization needs are not any more complex than the simple outline provided above. However, for many organizations, there are several key items missing that are needed for a more comprehensive solution. For one example, the current Oracle product does not audit individual steps within the workflow once the workflow has been completed. And what about integrating our metadata design into the content itself (which is often the case when you want information such as the version number or documented author merged into the document header)?
13 For these and other use cases, our own product, the Fishbowl Policy and Procedure Suite, is a perfect complement to a complete Policy and Procedure Management system. Built on top of the core UCM Content Server technology, the Fishbowl P&P product provides the following enhancements to Oracle s solution. Workflow Once content is through a workflow, the history of the workflow is no History longer readily available with the out of the box solution outlined above. The Workflow History feature included in the Fishbowl Policies and Procedures Suite delivers a detailed and permanent history of the workflows, including rejection comments which are otherwise lost. Users may also edit the columns seen in Workflow History and other reports through a Configure Workflow History Columns interface, improving ease of use for end users. Workflow The Workflow Search feature delivers insight into all content in Search workflow, along with the number of days it has been at each step, allowing organizations to have more insight into the workflow process and providing an easy tool to hold knowledge workers accountable for their part in the workflow process. Query based Provides notifications configured to specific days based on policy Periodic and procedure compliance standards. For any organization working Reviews under regulatory standards such as JCAHO, HIPAA and ARRA, the ability to proactively address policies and procedures before the necessary review date is essential to ensuring compliance. Native File Allows for pulling metadata from Oracle WebCenter Content, like Updater Revision Date, Author, Revision Level, Document Type, etc. and update information in a native file (e.g. populate a header or footer with this information) to ensure the content in your native files is in synch with the WebCenter Content Server automatically. This reduces human error and ensures compliance between the content within the documentation and the metadata residing in your Content Server. Query Based The interface of the Fishbowl Solutions Policy and Procedures Suite File Hierarchy allows for a simple and easy ability to browse for content that is based on metadata. This means the folder hierarchy doesn t depend on Folios or Contribution folders, allowing for the ability to easily manage and change the hierarchy, simply by updating metadata fields. Furthermore, this allows the hierarchy to be easily pushed through various delivery channels, such as an externally facing website. Subscription Provides the ability for proactive notifications and actions around Manager requiring action. For instance, custom notifications with specific policy and procedure review directions, automatic escalation on events, timed basis and user activity, and the ability to trigger, update, and query external systems for automatic synchronization.
14 Policy & The Policy and Procedure Suite by Fishbowl Solutions provides a user Procedure interface that removes many of the perhaps unnecessary tools for Dashboard those managing policies and procedures. Instead, the simple interface provides four main tools specific to those managing policies and procedures. For instance, the ability to search for specific policies and procedures, the ability to browse within the file hierarchy explained above, the ability to review which content items require periodic review, and the ability to view items that are in your workflow queue. The dashboard view is shown below. 6.1 Customer Case Study Primary Healthcare Provider One of our customers, a large primary healthcare organization based out of Minnesota was running all of their laboratory machinery using paper policies and procedures stored in threering-binders. The paper process was familiar and easy for the laboratory staff, but it didn t ensure that the documents were always up to date and that they were 100% in compliance with industry standards. It was imperative the hospital take action. The organizations requirements included: Documents and metadata should be managed at central point. Handoffs and distribution should be automated. Document versions should have unique version number ("watermark" number), to be located on each page of every controlled document. Guarantee that a printed document can be reconciled with electronic counterpart. Manage document templates (policies, procedures, forms, etc.). Manage document metadata including document type, document status, document owner, physical location where used, mailing list, and manual.
15 Generate master list of documents in various formats, e.g. by document type, by manual, by department, by document owner, etc. Log that a document review has occurred. Log every change in status of document version. Log that a document is not the current version (keep current list of archived and deleted documents). Log in the metadata the reason a new document version was introduced. Archive and lock electronic form of document and its attributes. Generate report identifying documents in a manual. Generate ad hoc reports of document attributes (metadata). The system should be intuitive to the point all Lab managers, pathologists, and technical specialists are able to develop and revise documents on their own, with a minimum of training. Since the organization already owned Oracle WebCenter Content, the best strategy was to migrate the current policies and procedures from the Axis database they were being stored in, to WebCenter Content and utilize a best in class system that they had already invested in. Additionally, with the requirements outlined above the off the shelf software, Policy and Procedure Suite by Fishbowl Solutions, provided the additional functionality that would allow them to meet all the requirements listed above without heavy customization. The solution provided them with the easy look and feel the technicians wanted, while also allowing for the auditing and reporting needs the regulatory standards required. For the hospital, the result was a policy and procedure solution built on a best in class Content Management System at low cost with little customization. 7 Summary As we conclude, we hope you have gained a broader understanding of not only the policy and procedure business case outlined above, but also, various ways in which Oracle WebCenter Content can help you solve those specific challenges. The purpose of this whitepaper was to cover the key out-of-the-box features of Oracle WebCenter Content as well as provide an overview of the Fishbowl Solutions add-on product, Policy and Procedure Suite, for extending WebCenter Content for more rigorous compliance or needs. While each organization is different and the regulatory standards by which they must comply vary, the overall needs are usually the same: auditability, periodic review, and dissemination of information. The organization must evaluate both your users requests and address the key needs mentioned and in doing so provide a solution that meets regulatory standards. The real world example of the requirements and solution one organization implemented hopefully shed light on how the technical and business strategy can be applied and allow your organization a jump-start in pursing a solution for your Policy and Procedure needs.