Promoting greater compliance and efficiency in output management includes digitizing and centralizing document output, ensuring HIPAA compliance and data security, maximizing operational efficiency, document management and retention, and staff training and culture. The work required is typically well worth the effort, resulting in reduced costs, lower risk, reduced administrative burden, and improved patient care.
4 Strategies for Safeguarding PHI in Output Management
Naturally, compliance and efficiency in healthcare output management starts with safeguarding PHI against any possible bad actors or misuse. This effort usually includes four key strategies:
1. Secure Printing and Document Output
From print jobs left unattended in the tray to print jobs intercepted on the network to print jobs forgotten in a printer’s internal hard drive, the journey from a computer or mobile device to the printer and beyond is fraught with peril. So efforts to secure this process must account for all possible threats.
For example, as print jobs are sent to the printer, they should be encrypted while in transit. Printers should be located in secure areas accessible only by authorized personnel. At the printer, secure print release should be mandatory, requiring the staff member to authenticate themselves before the document can be printed.
Saber Healthcare Group,, which provides consulting services to 125 long-term nursing facilities in the Eastern U.S. found success in implementing Secure Release Printing from PrinterLogic on the company’s network printers. This allowed users to authenticate seamlessly at the printers by entering a PIN code directly on the printer’s touchscreen to successfully keep PHI in print jobs secure.
2. Secure Shipping and Mailing
It’s no secret that physical mail and other shipped packages have long been a target for PHI-seeking fraudsters. That has not changed in the digital age. Naturally, safeguarding PHI becomes much more analog in this context.
For example, healthcare companies should ensure that the packaging used in mailed and shipped packages is opaque and adequately sealed to prevent PHI from being read from the outside. Tamper-evident packaging, with seals or tape that clearly reveal if a product has been opened or compromised, can alert an organization if highly sensitive documents have been compromised. In addition, trackable mailing services provide a well-established means to track chain of custody as a letter or package makes its way to its intended recipient.
Finally, because companies often partner with third-party print and mail vendors, they should ensure that these vendors sign a Business Associate Agreement that holds them legally responsible for protecting PHI.
3. Electronic Output and Data Handling
In many ways, this is the beating heart of output management, automatically transforming raw application data found in digital documents into communications that are secure, personalized, and actionable, and routing information to the appropriate digital and print channels faster, more accurately, and in compliance with regulation.
This includes using only secure, cloud-based fax services, using secure file transfer protocols, and ensuring that the organization collects, uses, and retains only the minimum personal data absolutely required to fulfill a specific, stated purpose.
4. Administrative and Operational Controls
This refers to the procedural and structural frameworks an organization will employ to keep document delivery secure, accurate, and efficient. These controls focus not on physical hardware, but on managing, defining, and monitoring document workflows.
This strategy includes making certain that printed PHI is disposed of securely. For instance, documents should be shredded and their remains locked in shredding bins in designated areas. It also includes training employees on clean desk policies (i.e. not leaving PHI on desks or printers) and proper reporting of print-related security incidents.
Perhaps more importantly, administrative and operational controls require comprehensive audit trails that track who printed what, when, and on what device—a task that is best accomplished via software. This information is critical in optimizing printer usage, supplies, and maintenance.
One example of this is the print-auditing capabilities of PrinterLogic, which allow IT administrators to see all print job statistics in an intuitive, exportable format. This makes a powerful tool for healthcare organizations to maintain a comprehensive view of all print jobs coming through their systems and ensure they are all properly safeguarded.
How to Implement Effective Output Management
When implemented effectively, output management secures document delivery, integrates output management software with EMR systems, manages both digital and physical output, and enables the organization to remain in compliance with regulations like HIPAA.
Historically, traditional output management, with its overreliance on manual processes and on-premise hardware, has struggled to fully meet these objectives. However, by replacing traditional approaches with new ones powered by emerging technologies, healthcare companies can fully realize the intended benefits of output management and then some. Here’s how:
1. Assess Current Workflows
Identifying bottlenecks and security risks within an organization’s print and document management workflows is essential in identifying opportunities to improve. This typically involves a systematic analysis of the organization’s whole document lifecycle, from the creation and formatting of physical and digital documents to routing and delivery. It includes understanding how information travels from ERP and EMR systems to the end recipient.
In this exercise, more comprehensive and trustworthy data yields more effective decisions and improvements. On the other hand, gaps or inconsistencies in the data will slow or stymie efforts to improve workflows.
2. Centralize Control
Output management thrives when all systems are adequately integrated, provide comprehensive, consistent data, and centralize control. Traditionally, however, output management has been plagued by outdated infrastructure and disparate, on-premise systems and hardware that fail to fully integrate with each other. When this happens, complexity increases as control over the workflow is fragmented. In turn, maintenance costs rise and local IT infrastructure experiences heavier loads.
The solution to this problem is to replace outdated infrastructure and on-premise hardware with centralized, cloud-native SaaS solutions. These are built to seamlessly integrate with EMR, ERP, and EHR systems, while simultaneously managing all output devices and channels. The result is one centralized, unified platform from which to analyze and optimize workflows.
3. Automate Manual Processes
In output management, manual processes tend to breed inefficiencies in a workflow. At any given step in the workflow, the time required for a person to recognize the need to act and then perform the required action is time lost in getting the required document or data to the intended recipient. On the other hand, automating workflow processes can make delivery nearly instantaneous.
Workflow automation works through automated, pre-defined criteria for routing, such as protecting sensitive data or balancing high-volume jobs across printers. It can be used for converting file types or enabling driverless printing.
While some automation can be achieved amongst disparate systems, fragmented systems like those mentioned above are not conducive to widespread automation and optimization. Therefore, in order to build fully automated workflows, truly centralized controls and unified systems are essential.
4. Ensure Reliability
In healthcare, printer failure and downtime can have a significant impact on operations and patient care. In traditional output management, IT teams wait for systems to provide real-time status updates on print jobs and then manually re-route or fix issues—an approach that still results in an interruption of services and a lapse in reliability. Here, automation presents a better way.
Automation can improve output reliability by skipping human actors to redirect print jobs automatically to other available printers, in the case of printer failure. When a high-volume print job comes through, automation can distribute jobs across multiple printers, so they can still be fulfilled in a timely manner.
5. Ensure Security
Secure print release, role-based access control, data encryption at rest and in transit, audit trails and logging, and centralized management are components of security in traditional output. However, if not properly managed, these traditional on-premises setups can be difficult to patch and scale, making them vulnerable compared to cloud-native alternatives.
To get truly secure output management, healthcare organizations need to take security a step further. They should employ a Zero Trust model to ensure that every user and device is authenticated and authorized before gaining access. Identity Providers (IdPs) should be used for multi-factor authentication to make print automation more secure and prevent unauthorized access.
In addition, they should use TLS encryption for data in transit and AES 256 encryption at rest to establish end-to-end data protection. Their output management system should be ISO 27001:2022 and SOC 2 Type 2 compliant to enable comprehensive auditing and tracking, while maintaining compliance with regulatory requirements. Finally, permission and access profiles should be granular and customizable to keep users or groups from accessing specific resources.
Navigating Compliance Challenges
Implementing these five approaches allows organizations to establish future-facing output management that removes complexity, reduces maintenance costs, and enables document workflow automation without getting bogged down by extensive hardware and manual oversight.
The more healthcare organizations automate the secure, accurate, and traceable distribution of patient information across disparate systems, the more manual, error-prone processes are replaced by digital, real-time workflows that keep organizations in compliance with HIPAA and other regulations.