Consequently, the all-too-familiar challenges associated with loose documentation continue to be a pain.  Loose documents take more time and resources to process than a full patient chart because batch scanning processes are designed for large volumes of paper and are not optimized to efficiently scan loose documents.  Therefore, HIM departments must dedicate resources to handle the individual processing of loose documents versus the batch processing of charts. As a result, HIM departments may not be able to reduce staff or required overtime as more paper charts become electronic because of the high percentage of loose documents.

To combat the growing challenges of loose documents, healthcare facilities should proactively analyze scanning processes and technology to optimize efficiencies.  For example, consider instituting a process that identifies loose documents when they arrive or research technologies that assist in extracting information from the documents during the indexing process.  Look specifically for day forward scanning technology that can utilize information within the document to automatically identify it and assist in indexing.

For the foreseeable future, loose documents are not going away, but they can certainly be less painful.  If you’re searching for a light at the end of the tunnel or the bottom to the stack of paper, learn more about EDCO’s proven solution for loose documents.

1. Take advantage of front-end verification
   Front-end verification takes place when a healthcare facility or storage vendor creates a comprehensive records inventory by logging each chart into a computer database that can be linked to the facility’s master patient database.  Front-end verification improves the speed at which requested files are retrieved, and consequently, will reduce retrieval costs.
2. Plan for records retention and destruction
• Review records retention policies
  Records retention policies often vary by state and healthcare facility.
• Box records according to the retention policy
  Following the front-end verification, records should be sorted according to the facility’s retention policy at the time of boxing.  If a front-end verification does not take place and records are boxed at random, then the hospital can run into unnecessary cost and liability issues associated with storing, retrieving, and destroying records.
• Plan to destroy entire boxes instead of individual files
  Most storage vendors charge by box and destroy by box.  If a hospital hasn’t sorted their records prior to boxing them, then likely they cannot destroy an entire box without paying the vendor to go through it and remove records that must be retained.  As a result, sometimes boxes end up half full, and hospitals must pay to consolidate the boxes or store all the partially filled boxes.
• Watch out for the double whammy in the fine print
  Check your contract before planning to destroy records past retention.  Other charges stem from retrieval fees, removal fees, and destruction fees, which in some cases are more than the cost of storage.
3. Reap the benefits
• Cost savings
• Bottom-line: Records storage isn’t free; reduce the quantity of paper records to diminish storage costs.
• Front-end verification allows storage vendors to review the records inventory and reduce the time required for retrieval; consequently, reducing costs for the healthcare facility.
• Reduce liability
• The healthcare facility’s health information management department is responsible for producing discoverable records. Following a front-end verification, destroy records past retention to reduce liable records requests.
• By reviewing the records inventory, both the vendor and the healthcare facility can feel secure knowing exactly what each box contains before it is destroyed.

Want to be savvier when partnering with a storage vendor?  Check out this webinar.

Begin with the end in mind

From the purchase of a new electronic health record system to upgrading or modifying configurations of an existing one, HIM and IT collaboration must start early, regardless of the scope of a project. 

Critical topics for discussion

• Business requirements - HIM should clearly and specifically provide the business requirements of the health record so that IT can ensure the system functionality supports those requirements.  This includes definition of the legal health record, process workflow of the chart, data required at each stage in the workflow process, and which users are allowed access and when. 
• Security requirements – Security related to types of users, location of user, auditors, and reporting are also HIM-defined requirements that IT will need to ensure are properly configured. 
• Checks and balances - Requirements, design, testing, and implementation must be developed together so progress and checks and balances are tracked throughout the term of the project.  This includes the definition and creation of dashboards and reports for tracking productivity, coding revenue, and work-in-progress.

Preparing for life after launch

After completing the project together, IT and HIM team members must provide sufficient training and knowledge transfer to the users.  Success is contingent upon follow-up observation sessions, which ensure that the desired efficiency and accuracy levels are being performed.  Healthcare technology is not static; facilities will always need updated versions, interfaces, and standards. Similarly, the relationship between HIM and IT should continually evolve and remain connected.

Take an introspective look at your facility

Is dialogue open and ongoing between your HIM and IT departments?  Are your departments working together to achieve the same goals?

In 2010, Dale Potter, Senior Vice-President and Chief Information Officer at The Ottawa Hospital saw electronic health records’ immobility as a limitation and challenge to overcome.  He also recognized the power of the iPhone™, a device his clinicians widely accepted. When Apple™ announced the release of the iPad™, a mobile digital device, Potter seized the opportunity to create “a really usable application on a device that will be adopted very easily by clinicians,” stated Carl Maisonneuve, Chief Systems Architect of The Ottawa Hospital.  Clinician acceptance of new workstations is a challenge many hospitals, including Ottawa, face.

To maximize the functionality of the iPad, The Ottawa Hospital needed a Clinical Mobile Application (CMA) of their PC based Oacis electronic health record (EHR) system installed onto the device.  Initially, the full EHR was not available, which excluded EDCO^® Health Information Solutions’ scanned records.  Feedback from clinicians demanded that the scanned records also be incorporated, so the hospital solicited EDCO’s help in delivering a solution.

Solution

EDCO presented The Ottawa Hospital with two options.  With first option, EDCO offered to write the code necessary to make EDCO’s web viewer compatible with the iPad’s native view.  The second option presented was to create an application that would allow clinicians to view patient records using the iPad’s native view.  The Ottawa Hospital chose the second option due to the simplicity and intuitiveness of the application.  By choosing this option, clinicians are able to view the EHR natively on the iPad. EDCO’s electronic document management system, Solcom, provided a set of Web service APIs utilized by the iPad application to retrieve and then convert the patient record documents to a PDF format that displays natively on the iPad.  Maisonneuve praised the solution, “The huge benefit for us is that EDCO’s documents on the iPad appear exactly like all the other documents on the native iPad PDF viewer.  From a user interaction and navigation standpoint, the capabilities of that viewer are the same whether you’re looking at the scanned documents or the PDF that comes from the EHR.  So that’s the big advantage, it makes the interaction with the user a lot simpler.”

Results

Since the initial launch, The Ottawa Hospital has achieved the desired results.  “So far, the feedback has been positive.  The most common complaint is that clinicians want more features,” says Maisonneuve, “We know we’re generally on the right track when that happens.”  The Ottawa Hospital is also starting to see improvements in workflow from using their 300 deployed iPads, which has influenced their decision to order 1,800 more iPads for the hospital and implement them by the end of the calendar year.  “It obviously streamlines the workflow.  If you don’t have to do three quarters of your work on an iPad and then walk over to a PC for the other quarter that makes it a lot more seamless. Clinicians can access whatever they need on the mobile workflow,” says Maisonneuve.  EDCO and The Ottawa Hospital are continuing to partner on improvements.  Michelle Leafloor, Director of Clinical and Support Solution Delivery commented, “We have a partnership that began over a year ago, and we’re continuing to look at different ways to work together as partners for providing better clinical workflow in the future.”

Electronic document management systems (EDMS) often play a very effective role in both achieving meaningful use and making hospitals more efficient.  By providing a document repository for all patient documentation that is not in the EHR, the EDMS enables a hospital to have a truly paperless environment.  The EDMS may serve as a long-term document repository or simply a bridge to a paperless environment until paper is no longer created.  In either scenario, the benefits to the healthcare provider are immediate. 

The meaningful use incentives are based on physicians entering more patient information electronically into the EHR instead of using paper.  Most hospitals are either in the process of rolling out or planning to implement solutions for computerized order entry (CPOE) and electronic documentation.  The success of these initiatives is directly linked to physician participation.  The best way to entice a physician to use an EHR is to make sure that all the information they need for patient care and electronic documentation is easily accessible.  

The health information management (HIM) department is a huge beneficiary of a fully electronic patient record.

The Value of Complete Electronic Records

• Frees HIM director from dual process caused by electronic and paper records
• Automates HIM process workflows for coding, analysis, and deficiency completion
• Allows for easy access to patient records for retrieval, packaging, and distribution
• Reduces failure to respond to audit requests because of lost or misfiled paper charts

Consider the goal.  Is it to reach meaningful use standards or meaningfully leverage electronic health records to improve patient care and processes within the hospital?  

Find out more about the financial and operational benefits of an EDMS here.

According to the AAPC, diagnostic codes will expand dramatically from 13,500 to more than 69,000 specific classifications. The change in procedural codes is no less significant; they will balloon from 4,000 in ICD-9 to more than 72,000 in ICD-10.  This major change in code sets is expected to impact efficiency in the health information management (HIM) department for the foreseeable future.

The Hybrid Records’ Negative Impact on Efficiency

Without doubt, ICD-10 is today’s hot topic.  Unfortunately, other issues that will affect the transition and the revenue cycle are lacking attention in the marketplace.  One such topic is how a hybrid medical record, a chart comprised of paper and electronic documents or existing in multiple locations, will impact ICD-10 coding and DNFB.

When the switch is flipped to ICD-10 coding, processing a hybrid chart could potentially cripple a health information management (HIM) department that is already behind in scanning medical records.  Delays in scanning cause delays in dropping the bill; this compounded by ICD-10 will create inefficiency in many HIM departments.

Alternatively, hospitals that have eliminated their reliance on paper are better prepared for ICD-10. Their efficient scanning practices and electronic environment allows for the utilization of electronic workflow to route records to and from coders with greater efficiency.  The ability to share documents electronically between HIM and clinical staff enables deficiencies to be corrected faster and charts to be completed and sent to coding more rapidly. 

When eliminating paper medical records by scanning charts within 24 hours of discharge and processing electronically, HIM leaders, coders, and clinicians will all have simultaneous access to the chart.  Coders will have access to the chart remotely, which enables HIM leaders to hire the most knowledgeable staff regardless of geographic location.

In today’s world of more to do with fewer resources, deciding where to focus time and attention is often difficult.   Although it might seem like adding one more thing to the to-do list, now is the time to analyze the impact of a partially paper chart and make proactive changes to prepare for the future. Eliminating the paper now may very well limit the headache later.

The Missouri-based company provides solutions and expertise in electronic document management, medical records scanning, records storage, and records retrieval. At its Technology Center in Sioux Falls,EDCOconverts medical records into an electronic format, which allows its clients to track, retrieve, and maintain records.

Chez Tschetter,EDCO’s Chief Information Officer, says the expansion will helpEDCOmeet the demands of its growing customer base.

“The healthcare, legal, and insurance industries are constantly expanding, and technology demands are growing too.  South Dakota is known for its strong workforce and will certainly help us better meet the needs of the clients we serve,” said Tschetter.

This month,EDCOwill start the process of hiring 30 more employees over the course of 2012. The company expects to hire for a variety of positions, including specialists, managers, and supervisors.  All positions offer medical and vision plans, as well as other benefits.

Helping the EDCO expansion, in part, was Workforce Development funding provided by the South Dakota Governor’s Office of Economic Development.

“In a time when the nation is seeing many companies downsize, it’s exciting to have a company continue to grow inSouth Dakota,” said Gov. Dennis Daugaard. “I’m pleased that the state can offerEDCOa hospitable climate for growth, and happy that EDCO is investing in South Dakota and its people.”

For more than 50 years, EDCOhas assisted hospitals in the digitization of medical records.  Today, EDCOGroup Inc. is comprised of two divisions and more than ten offices nationwide and in Canada.  For more information, visit http://edcohealthinfosolutions.com/about-edco.

Most bar code vendors will tell you the pros of implementing bar codes, including:

• Reducing errors for improved accuracy and patient safety
• Connecting dispersed information
• A quick, automated document identification process and movement of information for indexing

However, few vendors will highlight some of the disadvantages of bar codes, such as:

• The need for costly forms redesign (as much as $100,000 or more)
• Staff time consumed by the redesign process and implementation
• Time spent prepping documents for scanning by applying a bar code to each document
• Time spent on quality control checks as bar codes do not always read successfully
• Inability to bar code all document types

Even fewer vendors will inform you of alternative options like:

• Continuing in a paper-based environment for the short term
• The ability to scan and classify medical records using technology to recognize documents rather than bar codes

So, do your research, know your options, and choose the best solution for your hospital.

To learn more about the benefits of scanning without bar codes using Solarity technology, click here.

Key scanning benchmarks

1. Errors per 1,000 pages – A measurement of quality that is consistent over time will drive quality improvements and improve patient care.  The number of errors per thousand pages scanned when categorized will show trends and identify repetitive issues.  The root cause of issues should be acted upon quickly.
2. Loaded cost per image – Scanning is often a very costly activity without a full understanding of the total cost by the hospital.  It is difficult to break the cost down of the entire scanning process, but it is a necessary step to identify areas where efficiency can be improved and costs reduced.

To understand the loaded cost per image, look at each step in the process, and consider the following:

1. The number of employees currently scanning, and their annual salary including benefits.
2. The cost to label, print, prep, scan, index, and quality check the medical record.
3. When completing each of those steps, ask your team why they are performing the task in that way.  Too often, legacy processes are in place and team members are primarily concerned with getting the job done, increasing costs and slowing the revenue cycle.

In our experience, efficient HIM departments with years of scanning experience can scan at a rate of 8–10 cents per image.  Often, hospitals that have been scanning for a few years or less experience costs of 15–20 cents per image or higher, and the turnaround time on the chart exceeds 24 hours. Per image costs add up quickly. Often this cost is unknown to the facility.

What is your cost to scan per image?  For free help getting started on the analysis, contact EDCO^® Health Information Solutions.

The hybrid record environment of paper and electronic files, often dispersed between various systems and storage facilities, heightens the likelihood of a misfiled patient chart.  Although misfiles may be a reality, so is the liability that comes with them.  One misfiled chart if requested during an audit could potentially cost the hospital $100,000 or more which often warrants an “all hands on deck” search wasting extensive department resources.

One surprisingly cost-effective solution is to completely eliminate the facility’s medical record file room.  When the file room is eliminated, all charts are scanned, and misfiled charts are found, which greatly reduces the hospital’s liability related to lost charts.

To build a business case for file room elimination beyond the misfiled chart, consider annual hard cost saving opportunities such as reclaiming floor space for revenue-generation operations and reducing or reassigning file room staff.  Often, HIM departments utilize current file room staff for day forward scanning initiatives because adding to the FTE headcount can be nearly impossible.

Soft cost savings of file room elimination are harder to quantify, but efficiencies can be significantly improved by locating all files electronically in one location.  Typically, physician satisfaction improves when the EHR is prepopulated with historical patient information.  These soft cost savings, although intangible, provide improved patient care and support the greater goals of the hospital.

A file room analysis can help you determine if now is the time to say farewell to your paper file room.