Whitepaper paperless hospital

Whitepaper
Paperless
Hospital
Offering information digitally via smart document
management, digitalization and unlocking
information makes healthcare institutions healthy

Whitepaper Paperless Hospital in Healthcare | 3
Table of
content
Introduction 5
1. Free market system 6
2. On-demand healthcare 7
3. Innovation 8
3.1. The New Way of Working 8
3.2. Electronic patient/client records (EPD/ECD) 9
3.3. Bring Your Own Device 11
3.4. Tablets and mobile devices 11
3.5. Smart Communication 12
3.6. e-Health 13
4. Paperless Office: Information integration 14
4.1. Smart Digitalization 14
4.2. Smart Printing 16
4.3. Smart Management 17
5. Implementation 18
6. Conclusion 20
7. Ricoh 21
8. References 22

4 | Whitepaper Paperless Hospital in Healthcare
This whitepaper is written by Pieter Rahusen, Clara Aguilo and Lydia Goerig Market Development
Managers Healthcare, from Ricoh Europe. This document is meant for colleagues, prospects,
customers and relations from Ricoh. This whitepaper shows Ricoh’s vision about a paperless hospital
via digitalization and management of patient/client and company records in healthcare. Ricoh’s vision
is based on years of experience with information processes in European healthcare institutions. It has
led to a modular solution that consists of several building blocks. These blocks guarantee a seamless
integration of several processes. The solution also uses the standards from existing infrastructures and
work methods.
The existing primary business and care applications, the IT environment and the work methods are
therefore the starting point for change management. Ricoh’s healthcare specialists have a broad
understanding and knowledge of the procedures and laws within healthcare. This makes Ricoh
an excellent and reliable partner that can guide and support healthcare organizations with issues
regarding a paperless office.
This whitepaper describes the building blocks of the complete solution for Smart Document
Management from Ricoh. It enables healthcare institutions to gradually switch to a paper less hospital
(step-by-step). The goal of this whitepaper is to offer objective and relevant information that supports
the decision making process about the implementation of a paperless office.
Note: All references, sources and internet addresses were correct at publication of this whitepaper.
The authors cannot be held responsible for changes that have occurred in the meantime.
Authors
Pieter Rahusen, Market Development Manager Healthcare Ricoh Netherlands
Lydia Goerig, Market Development Manager Healthcare Ricoh Germany
Clara Aguilo Market Development Manager Healthcare Ricoh Spain
Christian Bonaccorsi, Market Development Manager Healthcare Ricoh Italia
Renee Dillon, Market Development Manager Healthcare Ricoh United Kingdom
Sophie Vu-Frenoy, Market Development Manager Healthcare Ricoh France
Ricoh Europe
November 2012
Reference

Introduction
Healthcare institutions want to cure or care for patient/ clients quickly, comfortably and with a high
quality level. That is the core competence of a hospital (Cure) or nursing and/or homecare facility
(Care). The IT organization of a healthcare institution supports that mission, at the same time,
healthcare institutions experience great pressure at the moment due to developments in economy,
society and laws:
On-demand healthcare.
Cutbacks and cost savings.
The quality of care should increase and be guaranteed.
Interchangeability of data between healthcare institutions.
Increasing demand for care and lack of medical staff.
Being able to work irrespective of time and place as medical employee (mobile equipment).
Patient and client (or parents) participation in the treatment process.
Higher patient and client satisfaction.
Attractive work environment and less work pressure.
Governance, Risk & Compliance.
These developments denote the importance of having information accessible in the right format, place
and time in places where patients/clients and medical staff meet each other. It concerns both physical
logistics, but also integration of data in an information structure system. Ricoh’s Smart Document
Management aims at less use of paper in healthcare via digitalisation and guidance in this change
process. It supports information processes as well as the physical treatment process of patients and
clients.
Digitalization of patient and client records and company data make treatments and care processes
more efficient and safer. It also links medical processes to administration processes in a healthcare
institution. This enables healthcare institutions to adhere to a business like approach. It saves
operational costs, makes healthcare institutions more attractive on the job market and increases
patient/client satisfaction.
A few trends that support a paperless office in healthcare have been mentioned above. It is usually
a compelling event, happening or development that forces organisations to rethink their document
structure. The preconditions are different for every healthcare institution. The introduction of a
paperless office strongly depends on the maturity level of an organization and the support from
employees and the healthcare institution. They are the ones that will have to work and live with it.
The solution is often a step-by-step introduction of the paperless office. In that way, an organization
can take the first step to a paperless office whenever they want.

Free Market SystemChapter 1
The European population is experiencing a ‘double’ aging population. On the one hand, we have had
the baby boom in the third quarter of 1945. Due to the post-war revival of the economy, the birth
rates remained high for quite some time: until 1965. In the period 1946 - 1955, many children were
born (the so-called baby boom).1
The first baby boomers of 1946 reached retirement in 2011. But
the problem is that the next generations will also live longer. By 2050, we expect to have 1.8 billion
people world wide who are over-80 years old. That is 10 percent of the population. It is clear that the
economy will then be focussed around service and healthcare. This applies especially to older people
that live alone and do not have a partner that can offer them support.2
The part of the population that will carry the costs for healthcare via premiums will decrease in the
next couple of years. The effect is that the collective provision for old age, the pension scheme and
healthcare will come under a lot pressure. The various European governments take a stand in this by
stating that it may not lead to deterioration of the quality, accessibility and affordability of healthcare.
In order to level the rising curve of healthcare costs as much as possible, the Market Decree Healthcare
introduces many laws throughout Europe. These laws contain rules for market organization, efficiency
and managed cost control in healthcare (free market system).3

On-demand HealthcareChapter 2
The purpose of the new law is to transform the traditional control of offerings into a free market
system based on demand. Ever since, insurers and care providers are negotiating the prices and quality
of care. Stronger competition between care providers stimulates them to deliver high quality care. In
the new healthcare system, the patient or client is central, market stimuli play a larger role and the
government withdraws more and more.
When the crisis started in 2008, the views on a free market system started to change. The social
trust in institutions like banks and housing corporations decreased immensely. According to the NVZ
(Dutch Association of Hospitals) it is not about the regulated free market in healthcare, but about the
performance affordability which enables competition on the level of quality, not on price.4
This development denotes the importance of on-demand healthcare even more. It means that parties
in the healthcare sector should work together to reach high quality and efficient healthcare that meets
the wishes of patients and clients. By putting the demand for care first, also means that there are more
possibilities for patient participation during the treatment process.
Patients/clients, but also healthcare institutions and volunteer aid want to be closely involved in
treatments. They prefer to be treated at home, with machines that they can operate themselves. It will
be possible in the future to counsel chronic illnesses by remote monitoring. The patient can pass on
actual data themselves, like blood pressure, heart rhythm values and weight. This also applies to the
prevention of disorders (Life Sciences).
On-demand healthcare means that healthcare should be seen in terms of yield or benefits, not as debit
or burden. Innovation is absolutely necessary in order to change this view.5

InnovationChapter 3
3.1. The new way of working
Reaching a top position in Europe is only possible when hospitals and healthcare institutions invest in
attracting more medical staff and specialists. In that process, costs must be controllable. It demands a
decrease of administrative positions that support the primary process. At the same time, the population
is diminishing and the demand for registering more information is increasing.
The demand for care, and therefore medical staff, will increase immensely in the next decades. When
the policy does not change, this will lead to severe understaffing. The problem is so serious, that the
growing potential of the whole economy will be affected. According to the dutch policy advisors of
the Ministry of Social Affairs and Employment, 540,000 to 750,000 additional jobs will be necessary
by 2030 in order to meet the increasing demand for healthcare.11
This trend urges hospitals and
healthcare institutions to start working more efficiently.
More efficiency is possible thanks to technological developments like fast, wireless broadband
internet connections, web based applications and early adoption of mobile equipment. You can
work with a desktop computer, but also on a laptop, tablet or smartphone. Working with these
technological innovations is called The New Way of Working. All the information systems mentioned
under 3.2 should be always available via the internet. The New Way of Working takes place on fixed
workstations, ﬂex stations, underway, on-site in wards or rooms, from the patient’s/client’s home via
several mobile devices.
Although technology has made The New Way of Working possible, this is not what is causing this
trend. It is caused by the request from new and future generations of employees to be able to work
irrespective of place and time. Employees in nursing professions ask for a more task oriented way of
working and they want to take responsibility for their own tasks. A professional should have the room
and responsibility to provide care led by their own judgment.
The rearrangement of tasks is one of the solutions for the capacity deficiency that healthcare is
facing. Otherwise (and shorter) trained professionals will take care of routine tasks of higher educated
personnel, whilst maintaining or raising the quality of care for the patient. It is important that a nurse is
authorized to indicate and practice routine acts.13
Room for trust in professionals means that more time can be spent in taking care of the patient or
client. It also means that less time is wasted in giving account and filling in forms. For many medical
personnel, this is a much appreciated change. In “The attractiveness of the Nursing Profession”
from the Nivel that has been published in 2011, nurses indicate that their profession becomes more
attractive if more nurses are hired and the organization of their work changes. Hiring more nurses
(75%), less administration (65%) and less work pressure (65%) make the nursing profession much
more appealing. Other measures that were mentioned were more equality between the top of the
organization and executives (74%), higher appreciation for the executives from management (71%)
and more self-controlling teams (61%). These numbers indicate that medical staff wants their work to
be organized in a way that everyone’s professionalism is expressed at its best.14

The New Way of Working enables people to work more efficient and be more productive. It relieves
the growing administrative burden and reduces the number of errors in manual and routine work. It
frees up more resources to do the actual job: providing care (or in a Dutch expression: more hands at
hospital beds). The transition to The New Way of Working is not easy for everyone. Many employees
have been solely responsible for a process. Now, they will also be responsible for the input, throughput
and output of information in that process. It also means a change for managers: they will have to
supervise more on the end result and not on the road to the end result. It is therefore very important
that the introduction of a new way of working goes hand in hand with change management.
Another benefit from The New Way of Working is that organisations can cut back on a number
of physical workstations. Less administrative employees will be necessary, because the hardcopy
information ﬂows have been digitalized. Healthcare providers spend less time behind a desk, but more
time underway, at the client’s home, in the ward or in the treatment room. At the same time, the
organization has to guarantee that all employees have access to the right information at all times.
3.2. Electronic patient/client records (EPD/ECD)
Information technology can be found in all corners of healthcare institutions. From diagnosis to the
operating room, from diets to treatment plans. Technologies are working faster and faster, and they make
fewer mistakes. Systems for processing company details and an optimal patient and client logistics make an
organization efficient.7
It also enables healthcare institutions to meet the demands of healthcare these days.
Healthcare that is geared towards the exact needs of the patient/client demands more than just well-
equipped hospitals or public healthcare services. It requires agreements, collaboration, adjustment
and direction between general and specialized healthcare institutions. Only then we can create one
combined healthcare chain, where we both carry social responsibility and explicit responsibilities.8
A combined healthcare chain is not a provision, but a form of care in which several medical staff from
different institutions work closely together to meet the demand of the patient/client.9
The healthcare
chain encompasses the information chain between healthcare institutions and external parties as well.
This is complemented by the internal information ﬂow of e.g. management, staff departments and
administration. Furthermore, vertical integrations of healthcare institutions are becoming a new trend
these days (e.g. between Cure and Care).
The challenge is complex due to the fact that a large part of internal and external information
exchange is still on paper. The risk of double records arises due to a physical and digital record. This is
inefficient and also damages the patient’s and client’s safety. Digitalization of documents so that patient
and client details can be accessed by authorized people anytime and anywhere is one of the great
benefits of IT in healthcare. It leads to electronic patient or client records (EPD/ECD).
In Europe some good examples of efficient processes across the entire healthcare environment are
findable. In Denmark for instance they use the most modern communication system. The general
practitioner is responsible for the patient record. He is the central person with access to all physical
examination results, radiographs and diagnosis by specialists. If a treatment by a specialist is necessary
the general practitioner as a central person has to approve this first. If a prescription is needed the
patient or nursing service can send a request by the electronic system to the general practitioner,
who places a check mark against the required drugs, which is then delivered on demand to the
drugstore via e-receipt. The patient then collects and pays for his drugs relevant to his/her treatment.
Every habitant in Denmark who is paying income tax has automatically compulsory health insurance
coverage. The standard and the patient satisfaction are extraordinary high. The system costs are on
average in comparison to the western European countries (9,7 % by GDP).19

Other European countries are in progress to improve health care efficiency to reach a comprisable
status. In Germany the hospitals started to implement electronic health records, partly they use it since
several years. A Ricoh customer for instance uses the EPR since 13 years and does not have any paper
based archives anymore. Hence the digital archive has a data volume of 4 TB. Every day 2.500 to 3.000
diagnostic findings are delivered in the system. The authenticated medical staff has an overview of all
residential times by every single patient and every diagnostic findings at a glance – and this in real time
and ﬂexible by a mobile PC. The advantages are more effectiveness, cost reduction by unnecessary
paper archive and improved processes, better documentation and a faster disposability and archiving
across all locations.
The NVZ (Dutch organisation Hospital integration) wants the Dutch hospital branch to be part of
the top of Europe by 2015.6
Reaching this goal would require a structured and efficient information
supply and a strong position for patients/clients. Innovation is therefore crucial for strengthening
the market position of healthcare institutions. Healthcare institutions would be able to exchange
information about patients/clients and their medicine use via an electronic patient or client record
(EPD/ECD). Unfortunately, the law that would regulate the rules around the EPD has been rejected
in April 2011. Nevertheless, the Lower House expressed the wish to use the already constructed IT
infrastructure. Electronic information exchange is of vital importance for the quality of care. In 2011,
the Health Care Inspectorate (IGZ) published the report “State of Healthcare 2011” about information
exchange in healthcare.10
In these recommendations, IGZ calls on all parties involved to start using
standardized information exchange as soon as possible, so that the chances for mistakes can be limited
to an absolute minimum. The IGZ mentions 1 January 2013 as the implementation completion date.
Together with the National IT Institute for Healthcare (Nictiz) and with support from the Federation
of Dutch Patients and Consumers, five umbrella healthcare organizations have taken the initiative to
keep maintaining and further improving the healthcare communication infrastructure (the National
Link, LSP). As a part of this, the Association of Care Providers for Healthcare Communication (VZVZ)
has been founded. Supervision on the private new start of the LSP is done by the CBP and IGZ. The
CBP supervises the use of personal details. The IGZ supervises the delivery of safe care that healthcare
institutions are obliged to deliver under the Quality Law for Healthcare Institutions and the Appeal in
Individual Healthcare Law (BIG law). The LSP is used solely for regional exchange of patient details.
As of 1 January 2013, patient and client details will only be exchanged if the patient/client has given
the institutions permission for exchange. Patients are also able to indicate if they want their details
to be exchanged on a national level. Nictiz will be responsible for the standardization of information
exchange. It is therefore essential to transform hardcopy documents into a digital, enriched and
standardized document form and add these to the information structure of healthcare and business
processes.
Source: Bain and Company: “The end
of Healthcare...as we know it?”: http://
www.bain.de/en/publikationen/articles/
the-end-of-healthcare-as-we-know-it.
aspx; August 2011, S. 15

Only then information will be available in the right form at the right moment on behalf of:
Hospital information systems
Client monitoring systems
Business information systems
Management information for the benefit of the decision making process,
and Governance, Risk & Compliance
Combined healthcare systems
The New Way of Working
E-Health applications
Quality requirements
3.3. Bring your own device
Thanks to The New Way of Working, a personal workstation is located in a handbag or jacket pocket.
People literally carry the device (smartphone or tablet) with them. It makes people more motivated and
productive, which is why it is no wonder that employers stimulate this. For many employees, it is not
very practical to bring two different devices though: one for personal use and the other for business
use. They prefer to work with a single device for both purposes. They also would like to choose their
own type and brand of device. They prefer to buy these devices themselves as consumer.
Employers are aware that adoption of The New Way of Working does not go with all sorts of
limitations. They will have to meet employees in this respect with a so-called concept of Bring Your
Own Device (BYOD). It implies a more ﬂexible approach to business policy and conduct with respect
to information and data security. And not to forget: the control that organizations have on devices,
the applications and the data stored on it. Management will therefore find itself split between two
worlds. On the one hand, management wants to show goodwill to the employees. On the other hand,
management will have to comply with the regulations that have been set for Governance, Risk &
Compliance. Measures need to be taken in order to combine the BYOD policy with the requirement of
being in control of systems, processes and data.
This situation requires solutions that support management in their pursuit to combine goodwill, security
and compliance. It does not only apply to employees and those who provide care. All parties in the
healthcare chain, including patients and clients, will become users of the healthcare and business system.
Mobile devices are usually physically connected to a person today. Management is facing the challenge to
set up a conduct and policy that applies to everyone in the organization, appropriate for the position one
has and the company resources one uses. This leads to a more transparent policy and earlier adoption.
3.4. Tablets and mobile devices
The forecasts for Europe are saying that the smartphones are growing at 33 % and tablets at 57 %
per year. It is expected that the data traffic volume will increase by over 90 % each year. The tablet
sales are driven by increasingly diversified product offerings and it will find one´s way into the business
world. It is anticipated that two thirds of European companies allowed tablets on their corporate IT
networks within 2012.20
It is not a strange development, because these devices offer great user-friendliness and are very mobile.
Users enjoy the benefits of many useful applications thanks to apps. Tablets are slowly appearing in
healthcare as well, at first mainly as replacement of hardcopies in meetings. The tablet is being used
more often in the area where the medical staff and the patient/client meet each other. Thanks to
the tablet, a direct interaction is possible with the information system of the healthcare institution.
The practitioner can view and update the patient’s/client’s record during contact with the patient/

client. Digital signatures are another application that greatly benefits mobile users. Tablets can show
automated form templates. With the use of smart software, these forms are transferred to tablets and
the details can be filled in and processed automatically on the spot. If the user prefers a smartphone or
the classical ball pen the forms can be filled in and automatically transmitted into the system, too.
Other applications of tablets in healthcare are:
Consultation
Supervision
Support at providing care
Determining urgency
Counselling/Instruction
Remote control
Material ordering
Patient registration
When using mobile devices in healthcare institutions, it is important that these fit in with existing
systems as much as possible. Healthcare institutions also have to think about the future. Strict
authentication must be possible to avoid that everyone has access to business information on the
device. Data encryption enhances data security even more. The devices should also be equipped with
applications that can read barcodes or create digital signatures, whilst being linked to the main system
at the same time. Also important in designing a mobile architecture is to choose devices where you can
add applications as you go (modular application).
3.5. Smart Communication
Although technology cannot take the place of a visit to the family doctor, video conferencing are
emerging as powerful components in telemedicine and telehealth initiatives worldwide. The integration
of video conferencing into these programs has been able to help many patients, and has enabled
doctors to communicate with specialists in order to make critical diagnoses faster.
Telemedicine is the use of medical information that is exchanged from one treatment site to another
via electronic communications. The term telehealth is closely related to telemedicine. It describes
remote healthcare that may or may not include clinical services. Both telemedicine and telehealth may
comprise videoconferencing, transmission of still images, document sharing, e-health (patient portals
for example), remote monitoring of vital signs, and some of the application areas noted below. Many
medical specialty areas have taken advantage of telemedicine including: dermatology, ophthalmology,
mental health, cardiology and pathology to name a few.
Ricoh’s Unified Communication System provides an optimal system and cloud services which can unify
data such as video, voice, documents, text and handwritten input, enabling communication between
patients and doctors “anytime, anywhere”.
Ricoh’s UCS can help to empower the growth and evolution of telemedicine and telehealth. Some of
the services that Ricoh’s UCS can enable or facilitate are:
Continuing medical education for health professionals and special medication education seminars
for individuals and groups in remote locations
Nursing call centers for referrals and patient services
Patient consultations: Audio, video, and data are shared between a patient and physician for the
purpose of rendering a diagnosis and subsequent treatment plan
Specialist referral services usually involve a specialist assisting a general practitioner in rendering a
diagnosis. Videoconferencing enables the patient to see a specialist during a remote consultation
accomplished in real-time. This is especially important for patients living in rural areas, or who are
too ill to travel great distances to visit a specialist or clinic.

Ricoh’s Unified Communication System provides the following relevant advantages:
The ability to conference with more than two people at a time.
The ability to include application, desktop and document sharing in the same session in conjunction
with a videoconference.
And most importantly, the ability to connect virtually any patient and doctor, anytime, anywhere.
This is really a combination of using P3000 UCS, Ricoh’slight-weight and portable device and using
standard PCs, tablets and smartphones with Internet connections.
3.6. E-Health
Before you can call on healthcare and support, people will have to make a move first. People are
responsible for their own health in the first place. They can easily search and find information about
relatively easy complaints (e.g. head cold). People can solve many problems by self-care. More ability
to do things independently and self-management of people creates more time for the professional to
provide care to patients and clients that really need it.17
The popularity of mobile devices like tablets and smartphones help the adoption of remote applications
in healthcare. Patients and clients can measure their blood pressure, weight or other medical values
themselves via an application that has been developed especially for that purpose. The data is
automatically sent and processed via the internet. Paediatricians and public healthcare services can
execute a consult via teleconferencing. It is also a real relief for volunteer aid and healthcare partners to
be able to remotely check up on patients and clients.
The devices, applications and technical infrastructure that will support this for health, welfare and
healthcare come together in the term e-Health. E-Health can contribute to a different way of providing
care. It can even (partly) replace care.

Paperless office: Information IntegrationChapter 4
Arranging univocal, complete and automated information is one of the most effective steps that
healthcare institutions can take in order to address the issues mentioned earlier. A paperless office
will only be possible with an end-to-end solution for the whole information infrastructure (from data
distribution to storage and deletion). This solution also guarantees information integrity. This is possible
via the application of version management and policy rules. You can control access to information via
access rights based on the roles that several employees have within a company.
An end-to-end solution for a paperless office consists of hardware, software and services for document
and information management. Like the word indicates, an end-to-end solution for a paperless office
consists of a combination of several building blocks:
Setup of a smart approach for implementation
Smart digitalization
Smart printing
Smart deployment of software, hardware and infrastructure
Smart implementation
Smart securing of the change process
From the point of view of cost savings, it is important that this solution makes optimal use of existing
infrastructures and connects seamlessly to existing business and care applications. Furthermore, the
solution offers a seamless integration with healthcare information systems, which also supports the
primary processes of a healthcare institution. Links to business systems for secondary processes like HR,
administration or finance all run perfectly smooth.
A paperless office is created by digital input, throughput and output of information and digital
information management. It concerns scanning, faxing, copying, printing and storing documents.
A paperless office therefore starts at a Multifunctional Printer (MFP), a device that combines the
functionalities of a printer, copier, fax and scanner.
This MFP supports the entire information ﬂow. The integrated functionalities ensure that there is only
one place where information on paper enters and leaves the organization. With MFPs, healthcare
institutions are able to gain their first cost savings, because these machines allow consolidated printer
ﬂeets within hospitals. Fewer machines have to be purchased, managed and maintained.
4.1. Smart Digitalization
The stored information in the primary healthcare system and business systems of a healthcare
institution should be available online. Unfortunately, much information is still only available in
hardcopies. This is usually information in the form of physical or psychological tests, but also reports
about the diagnosis, the decided treatment and the progress of treatment. Referral and discharge
letters and notes of conversations and findings of (former) medical employees or consulted experts
are still provided on paper. Patient record archives are usually still endless rows of cabinets filled with
hardcopies.
Entering data on paper in digital systems is a time consuming and complex process. Simply scanning
hardcopies is insufficient for integrating data into hospital and/or business information systems. The
scanned information is unstructured, which makes it important to enrich scanned data with metadata.
This makes the information withdrawable and searchable at a later stage. It also demands connection
with a logistic system that correctly classifies, orders, routes and stores the information. It therefore
requires a scanning process that consists of a combination of hardware, software and services.
Smart Scanning is a good example of such a scanning process.

Smart Digitalization does not only make information dynamic, it also makes it possible to save
documents sustainable and for a longer period of time whilst the authenticity remains demonstrable.
That is what makes Smart Digitalization a practical solution to digitalizing both medical as business
archives. Many hospitals have experienced the transfer from hardcopy to digital records. This was
usually a one-off action performed by third parties on-site in a specialized scanning street with high
volume scanners. Now that the files have been digitalized, all other files that need to be added to
the record need to be digitalized and enriched. The infrastructure of these MFPs is very suitable for
digitalization of these new documents. The smart scanning processes on behalf of the digitalization of
hardcopies and patient records is also applicable to business documents like statements of expenses,
invoices, purchasing orders and assessments of HR records.
The unstructured data that has been classified by Smart Digitalization can be integrated into the
(partial) hospital and business information systems. During indexation, a link is made between the
document and the EPD as well. Related data from the ZIS and the business system are also linked,
so that it all comes together in one record. Because the HL7 standard is applied in this process, the
scanned data fills these systems seamlessly, uncompromising and automatically.16 Subsequently, the
data from both sources are compared to make the data actual, accurate, correct and complete. This
process eliminates duplicated, old or incorrect data from the underlying databases, which increases the
value of information considerably. The right information will then be available in the right form and
accessible for the right user at any time.

4.2. Smart Printing
Smart Scanning converts hardcopies into digital information. The software that supports this process
takes care of correctly classifying and indexing of the data. This makes information throughput
and storage efficient. With respect to the output of information, MFPs also offer a solution: Smart
Printing. Hospitals can realize serious cost savings with this solution. Until now, many departments and
individual workstations had their own printers. These machines were relatively cheap to purchase, but
became expensive in maintenance and consumables due to the print quantity.
These days, many hospitals question whether they still need so many print facilities. Most of the
information is not printed anymore, but available via email or other applications. Information is
read from computers, laptops and smartphones today. This offers an opportunity to consolidate the
printer fleet. It is important though to do this with careful consideration. Printing needs to take place
under the Dutch standard for Information Security NEN 7510, which is a relevant guideline for the
healthcare sector. Another thing to take into consideration is the fact that in the primary healthcare
process, certain standalone printers will need to stay in place due to areas where patients need to
take documents with them or where barcodes need to be printed. In many other work places, in both
the primary as the secondary work process, individual desktop printers can be easily replaced by one
centrally located MFP.
Depending on the prescribed maximum by the law or the minimum standard set by the hospital, MFPs
can be placed on walking distance on strategic locations. The location can be a department, but also
locations between several departments.
An ideal printer fleet always consists of a combination of printers and MFPs. Many benefits can be
realized by integrating these in one agreement. The machines would fall under the same Service Level
Agreement and use the same reporting method for administrators. A lower number of machines also
means less usage, consumption, management and maintenance costs. Savings from 10% up to 30%
are common and realistic and some hospitals even save up to 50%.
When reorganizing a printer fleet, it is important to start out well-prepared (accompanied by a good
policy). You can look into the decisions that other hospitals have made already as a guideline and see
what kind of results they realized. A supplier that has been operating within the healthcare sector for
many years possesses this kind of information and can objectively advise you on the decision where to
place machines and which machine types you need. The supplier can also help you set up a user right
policy.
The difference between printing and Smart Printing is primarily controlling and monitoring usage.
If you do not monitor usage, operation costs can rise considerably due to an increase of network
devices and rising output costs. In collaboration with software supplier Equitrac, Ricoh developed
Equitrac Office. This application measures and manages document output on MFPs. It makes it possible
to closely monitor print and copy activities. The costs are controllable thanks to easy and accurate
assigning to specific persons or departments.

4.3. Smart Management
Smart Digitalization and Smart Printing enables healthcare institutions to gain control and provide
insight into scan and print behaviour, reproduction costs and information flows. Primary and secondary
processes become more efficient and hospitals save loads of time and costs for management. Smart
Management of printer fleets is simple thanks to integration with existing systems. All data and user
rights are registered in the Active Directory (AD). The equipment communicates with the AD when
employees log in with a user card or login code. In this way, they do not have to be registered twice.
User rights can also be adjusted for direct output to the most efficient machine. Equitrac controls this,
an application that sets up and enforces print rights and policy rules. For example, an employee should
only be able to print a document when he/she is physically standing at the MFP. It can also prevent
unauthorized printing and copying, or exceeding the print limits for colour output. Because the rights
can be based on job position, level or even individually, document security is guaranteed. Equitrac
provides insight into machine use, which enables efficient deployment of your machine fleet.18
A personal login code or access card makes user management simple, but it is also a great advantage
for employees. Medical staff often works on several locations. Thanks to Follow-Me Printing, employees
can make prints on a MFP of their choice. Print jobs will not get lost anymore and employees do not
have to wait for their prints when a machine is in use.
If all MFPs are equipped with the @Remote application that supports management, central data
collection is possible. It also automatically generates and sends counter, service and consumable
reports to the administrator. This information can be used for invoicing and automatic ordering of new
toners. Service information is always directly available to the administrator, even when management is
outsourced. This enables administrators to intervene proactively and act before problems arise, which
increases the availability of the printer fleet.
The MFPs are not limited to digitalizing hardcopies. Thanks to the Ricoh HotSpot Printing service, MFPs
can also connect with smartphones or tablets via wireless internet. For example, you can send a print
job to a MFP from any mobile device. Just like hardcopies, the purpose of the ‘print job’ can be to send
data. The data is sent via a wireless connection. The employee logs into the HotSpot Printing service. It
provides double security: the employee has to be authorized to gain access to a space where the MFP is
located and has to have access rights to use the company network.

ImplementationChapter 5
This whitepaper described a few trends that stimulate a paperless office in healthcare. These trends are:
the increased use of mobile devices (BYOD), the wish for more efficiency and productivity in healthcare
institutions, support for employees in the healthcare chain, and The New Way of Working. These
trends are all centred on the wish to access information at any place and time, whether it concerns
adding or retrieving data. Information needs to be available quickly and must be easy to find. And that
is difficult in a world that still evolves around physical documents. Which trend lies at the bottom of all
this does not really matter, as the introduction of a paperless office largely depends on the ‘maturity
level’ of an organization.
Level 0 contains organizations that have no digital archives. All data is stored physically and managed
occasionally. No agreements have been made about central archiving. On level 1, organizations do
have a digital archive that brings sources together in a digital environment. They have made the step
from hardcopy to digital document ﬂows. That is where it ends though. No measures have been
taken to unlock digital data to make it searchable. Access and user rights have not been enforced
yet. Organizations on level 2 do use access and user rights, though limited. There are possibilities
to work in documents and share these. Digital information has become interactive. Level 3 takes it
one step further and regulates the user rights for retrieving and adding information based on roles.
Organizations on level 4 have fully integrated data systems. Adding, searching, finding and managing
digital information is possible within all systems and processes, irrespective of time, place or device.
The reason for healthcare institutions to get off level 0 is not always a trend. Usually, a compelling
event forces organizations to think about digitalization. Cutbacks may be a motivation or compliance
with new laws and regulations. It may also be a wish from within an organization. The intrinsic reason
will be different for every organization.
Whether started by a trend or compelling event, the crux is always to take the road to a paperless
office step-by-step. Only then innovation can take place, without overburdening the organization or
end users with changes. This can be realized by adjusting the existing systems and processes as less as
possible.

But which step should a healthcare institution take first? This depends on the situation. Sometimes, it
is desirable to start with conversion from physical to digital information. However, it can seem pretty
daunting for companies to digitalize gigantic hardcopy archives and records. Moreover, companies like
healthcare institutions often have to take laws and regulations into account, like storage time.
Another first step may be the design of a new, correct infrastructure. In order to facilitate optimal
information accessibility in a paperless office model, existing systems and applications may need to
be adjusted or renewed. New licenses, Service Level Agreements and measures for management and
maintenance need to be put into place.
Organizations might also run into information security issues, especially when it concerns the security
of personal and patient details. How do we regulate who has access to which information, how do we
guarantee integrity and how do we protect the data from cyber criminals and unauthorized people?
A paperless office is not just a matter of technique. It may be the case that the first hurdle is the
employees. They will want to have access to a lot of information, but how does the organization
guarantee that they get only what they need, at the right moment? Can employees live with that or
will they offer resistance to this new way of working?
Whether it concerns information accessibility, security or behaviour, the success of a paperless office
mainly depends on the policy that is employed. That is the reason that some organizations want to
formulate the policy first, think about how to introduce it and how to supervise compliance. This starts
with a clear insight into the definition and added value of information, though this will be different for
every organization.
Of course money is an issue too. Many organizations therefore ask us the question: what does it cost
and what does it yield? The yield cannot always be expressed in terms of money. Satisfied employees
and customers are not a debit item on a profit or loss account, though crucial for business continuity.
Sometimes, the first barrier can be the simple question as to which step to take first. The developments
around a paperless office are going fast and new solutions are introduced on the market each day.
The technology is there, but it is about finding the right connection. This requires support from a
consultant that understands healthcare institutions. Only then it is possible to make a thorough analysis
of the current work processes, business and healthcare processes and targets. Based on those figures,
a proposal is made to improve these processes via smart information management. The next step is to
set up a collective approach with a timeline for realization. The route to change takes adoption of new
work processes for employees, patients or clients into account. Afterwards, the partner can take over
and continually improve management and maintenance of this environment. Healthcare institutions
that already have plans, but have not yet undertaken any action, can involve experts at an early stage.
For healthcare institutions that have already taken some steps, consultants can join in at any level.

ConclusionChapter 6
A paperless office optimizes healthcare, makes business and healthcare processes efficient and reduces
the risk of administrative mistakes. Information is always and everywhere accessible in the right form,
and is based on access rights. An important condition is that information is available to users whenever
and where they need it. This is an essential difference, because no matter how good information is
entered and stored in systems, users should not have to search for information. This information should
be present at the moment the user needs this information.
The first step towards a paperless office is different for every organization. That is why it is wise to start
small and enjoy quick wins. You can realize these without major changes to your existing environment.
The role of the people in the change process should not be underestimated either. Help from an
expert with knowledge, experience and expertise in the area of a paperless office and information
management in the healthcare sector is indispensable.

Ricoh
Ricoh distinguishes itself in the market with many years of experience and knowledge about document
related issues in the healthcare sector. Ricoh’s solutions portfolio has an unrivalled ﬂexibility and
scalability. Ricoh has over 30 years of experience in consultancy, document management and output
management and has built up a strong and reliable reputation in healthcare. This enables Ricoh to
support healthcare institutions in changing their document input, processing and output environments.
It is obvious that this document does not provide the answer to a paperless office. Experiencing it
in practice is always the best. A continuous dialogue between Ricoh and its customers is therefore
very important. Ricoh will introduce an online platform around the Paperless Office theme shortly.
This gives everyone that has an interest in a paperless office the chance to exchange information and
experiences. That is how Ricoh paves the way to a paperless office with all parties involved.
Chapter 7

ReferencesChapter 8
1. Source: Central Bureau for Statistics (http://www.cbs.nl)
2. Source: Research ‘Baby boomers: wrinkling of a baby boom’, Central Bureau for Statistics (http://
www.cbs.nl)
3. Market Regulation Healthcare Law, Orders and Decrees 415, © Sdu Publishers, The Hague
4. The Netherlands: Top Healthcare Country - Belonging to the top of Europe. Strategic document
2010/2015, Association of Hospitals (NVZ) (http://www.nvz-ziekenhuizen.nl)
7. Patient and Information structures, © Ricoh Netherlands BV. Whitepaper about guaranteeing
business continuity in hospitals in a free healthcare market.
8. Definition of the National Council for Public Healthcare, 1995 (later: Public health and Healthcare
Council, http://www.rvz.net).
9. Association for Combined Healthcare (http://www.transmuralezorg.nl)
10. Report “State of Healthcare 2011”, a publication of the Health Care Inspectorate, October 2011
(http://www.igz.nl)
11. Report “Understaffing in healthcare”, Economic State Messages 95 (2010) 4598 p. 726 – 728
12. Labour Market Letter: Trust professionals (Schippers and others, 2011)
14. Report “The attractiveness of nursing professions 2011”, NIVEL 2012 (http://www.nivel.nl)
15. Source: Research “Trends in Digital Media”, executed by Intomart GfK in collaboration with
Cebuco, Vinex and PMA. http://www.intomartgfk.nl
17. The international US Health Level 7 (HL7) organization aims to set standards for interoperability that
improve healthcare, optimize work processes and stimulate a univocal policy.
18. Source: http://www.ricoh.nl/producten/output-management-en-veiligheid/s_equitrac.jsp
19. Source: Bain and Company: “The end of Healthcare...as we know it?”: http://www.bain.de/en/
publikationen/articles/the-end-of-healthcare-as-we-know-it.aspx; August 2011, Page: 15
20. Source: GSMA: http://www.gsma.com/publicpolicy/wp-content/uploads/2012/04/emofullwebfinal.
pdf, 2011, Page: 2; 22

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