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Huntington Internal Medicine Group

Tired of combing through storage rooms overflowing with paper? File cabinets filled with optical disks are becoming a popular alternative.

Doctor's Laboratory in Valdosta, Ga is a regional reference laboratory with 18 satellite locations in Georgia and Florida.

For years, two elements have fueled the lab's success. The first is a steady demand for blood tests. The second is paper... lots of paper.

Each day, the lab gets 5,000-to-6,000 pages of requisitions that accompany blood samples, says Dan McLeod, management information systems director.

While all of that paper fueled the operation, it also clogged the organization's information arteries. About a year ago, McLeod and other managers decided it was time for a change and decided to replace the old microfilm system and at the same time resolve issues like storage space, document retrieval, and data integrity.

"As a private lab, we are required to have the paperwork readily available," says McLeod. Storage space and difficulty finding documents were concerns.

Doctor's Laboratory converted to a document imaging system. Today the lab has over a million pages of computer output to laser disk [COLD] data stored on optical disks. Using the OptiMaxx Optical Information System from MedPlus, the paper requisition forms are scanned directly into an optical system. The amount of new storage space needed has been cut, and the turnaround time for storing and retrieving records also has been dramatically reduced.

"We are able to retrieve a scanned document in minutes now," McLeod says, noting that before it could take laboratory staff hours of searching for paper documents. "This has improved productivity and overall service to customers."

Doctor's Laboratory is one of many health care facilities that are becoming believers in document imaging systems.

Storage rooms and warehouses overflowing with mountains of paperwork are being replaced by filing cabinets filled up with optical disks (ODs).

About 55 percent of the 62 health care-related companies that responded to a 1996 survey by the Association for Information and Image Management International (AIIM) said they would expand their document imaging systems. Of those, about 27 percent made specific plans to expand last year with the remainder planning to expand in 1997 and beyond.

What is an imaging system? The AIIM survey defined electronic imaging systems as "...integrated hardware/software solutions used for capturing, storing, retrieving, transmitting and managing paper-based documents in digital image form."

AIIM says that imaging systems can help organizations to reduce or eliminate paper storage and manual filing while improving security and control over information. In addition, by integrating imaging systems with workflow, organizations can automatically route image-based information, which can lead to even greater productivity than imaging by itself could deliver.

"The document management market is more than one market: from production systems that handle large volume to desktops for smaller volume," says Priscilla Emery, senior vice president, information and services, for AIIM.

Whether large or small systems, besides saving space and retrieval time, most imaging products also provide a high-quality image that is clear and easy to read. Many microfilm systems have a hard time delivering the same readability.

Imaging systems also help protect document integrity. Because the documents are scanned onto disks in a write-once read-many (WORM) drive, the data retains the integrity of paper documents.

"The scanned substitute is acceptable as a substitute for the original paper request," McLeod says.

Most document imaging systems on the market today also offer COLD technology. This involves the storage of documents on disks that were generated on computers.

When McLeod was shopping for a system, he sought a vendor who is familiar with the needs of a health care facility.

"We looked at different systems for about a year before we settled on the MedPlus system," he says. "They were very realistic when they gave their presentation about what the system was capable of. We told them what we needed. They were up front--not wary of pointing out any limitations."

Previously, the lab was producing its own microfilm on site and a member of the staff was spending up to five hours per day microfilming an average of 2,000 forms per day. Once the film was shot, it was sent out to be processed by outside vendors.

Medical facilities such as Doctor's Laboratory were having problems with deterioration of film which could affect a court case where the film has faded, says Jeff Jordoff, a representative with MedPlus. "Data stored on optical disks has an estimated life of 30-years," he says, however, "microfiche--if exposed to sunlight--will fade in three to five years depending on how you store it."

After spending a couple months testing the system and staff training, the system went live in January 1996, McLeod says.

Using a juke box holding 16 optical platters, each 2.6GB double density, the system has a capacity in excess of 40 gigabytes. The dual-sided ODs can hold up to 10,000 scans each, 650,000 pages of digitally originated forms or 2,200 pages of microfiche.

The system has the added advantage of full-text indexing, which allows users to instantly retrieve documents by typing any word, phrase or number.

Periodically, patients will call the lab to find out specific information from an order form for lab tests, McLeod says. In the past, it could take days of searching through stacks of files for original and microfiche copies. Today, it only takes seconds to key in order form numbers to retrieve a scanned-in version of the original form.

Before implementation of the MedPlus system, McLeod describes the retrieval of paper documents as a daunting task, taking hours of searching for documents in a warehouse to find the proper forms. To meet legal and regulatory requirements, the lab kept reports and documents there for five years.

The new system also has made Medicare audits much easier.

"They pull a sample of patients to verify the tests that were ordered and they were billed for," McLeod says. "The scan is an acceptable substitute for the original paper request." The once time-consuming audits now only take minutes to retrieve the scanned documents from the optical disks, which can then be printed, faxed or sent electronically to the appropriate mail box.

Jim Evans is the Associate Editor of Health Management Technology magazine.

Borgess Medical Center:

"We never thought... it would be as successful as this."

Borgess Medical Center, a 420-bed multi-disciplinary hospital in Kalamazoo, Mich., implemented Dynamic Healthcare Technologies' Medical Records Plus/400 document imaging solution in 1993.

The hospital, which has a certified Level II Trauma Center, installed the system in the area where speed is most critical--the emergency department. Medical RecordsPlus is an enterprise-wide document imaging solution. Based on the IBM[R] ImagePlus[R] image processing system, the system receives information from scanned paper documents or directly from existing provider information systems.

Users have the option of selecting an OS/2[R] or Windows 95 desktop. Through a business agreement with IBM, Dynamic markets the product and provides customer services and support as well as software maintenance, support and enhancements.

Sally Korth is a former ER nurse who was given the challenge of implementing the document management system in the emergency department.

"We started with three workstations and within six moths we had six," says Korth, the clinical project leader for patient care technologies.

Previously, when doctors in the trauma center wanted a record from a patient chart, a call was made to health information services and a clerk retrieved the file and walked seven minutes to the emergency department. More, over, charts were only stored on-site for two years, then were stored off-site.

"We now have three years of patient data stored in the system," Korth says

Now that document retrieval is done at a workstation in the emergency department, patient care is enhanced because physicians have access to more complete information. The development of interfaces with key clinical areas transcription, laboratory and radiology reports--imported automatically, as well as EKGs imported via fax, have been integrated into the Medical Records Plus system as well.

Currently, 4,000 documents are viewed at the workstations every 24-hour period and 280,000 pages are put in the system each month. Sixty-eight percent are imported electronically, with the rest optical scans, Korth says.

Now doctors have, at their fingertips, any record or dictation on the system. Instead of sorting through paper files, the system allows doctors to review information on a patient from the emergency department PC.

Today, the system is used in the GI lab, prenatal clinics, peripheral vascular lab, occupational and physical therapy. One of the most recent implementations was in its new 150,000 square-foot, state-of-the-art Woodbridge facility in Portage, 13 miles southwest of the hospital.

"Two workstations were installed at a visiting nurse station that provides home care," Korth says. "Any care they provide can be scanned into the system as well."

Behind the visionary direction of Dave Thompson, vice president and CIO of the medical center, Korth says the hospital has been able to take a leading role in the clinical use of document management systems.

"We never thought in our wildest dreams it would as successful as this," Korth says.

Ultimate Health Services. On the way to a paperless records system

Opening a remote location in September 1995 led to document imaging for the Huntington Internal Medicine Group, a 38-doctor practice in Huntington, W. Va.

The group stationed four oncologists at an off-site location, St. Mary's Hospital in Huntington.

"Moving the oncologists to St. Mary's precipitated the need for a document imaging system," says Barry Wyant, chief operating officer for the group, which in mid-1996, formed a new company with the hospital and is now known as Ultimate Health Services Inc.

Through Access Systems of Charleston--a Minolta Corp. Business System Division reseller

the group installed a Minolta MI3MS 3000 Information and Image Management (I&IM) system.

The optical disk-based imaging system allows users to create applications to capture and store document-based information in an electronic file folder and retrieve these documents in a few seconds. When retrieved, the documents can be displayed on a terminal, printed, faxed routed via E-mail, or sent over the Internet.

"We put scanning and retrieving stations in the hospital and the doctor's office linked by a network so chart information on optical disks can be transmitted or brought up on either side," Wyant explains.

Quite often, patients seen at the office are moved to the hospital, and vice-versa. "It was a matter of getting information more quickly," he says.

The system has worked so well, the COO has begun a program of expanding the system to encompass electronic storage and retrieval of patient records.

The remainder of the group's patient files--about 70,000 with an average of 48 pages each--are being scanned, indexed and stored on the MI3MS 3000 system.

File documents are stored on a Minolta AC 1424, 5.25-inch WORM, 25-platter jukebox. Wyant estimates that about 1,500 patient files can be stored on each disk. Workstations in each of the practice's departments allow charts to be retrieved, referred to and appended by the doctors while treating their patients.

"Just to have information on patients has really helped," Wyant says. "The biggest problem is getting the doctors to remember to give the information to be scanned."

Getting "completely" away from paper-based records is another goal of Wyant's.

Wyant believes Ultimate Health Services Inc. will soon have a completely paperless records system, "probably a 15 to 18 month process."

University of Alabama Health

Services: Imaging "works well for us"

Just over a year ago, the University of Alabama Health Services Foundation got its document imaging system up and running.

The 250-physician practice located in Birmingham was in dire need of a modem document storage system.

"Originally we just wanted to get rid of paper and replace an old microfilm system that [the vendor] wouldn't even come out and repair anymore," says Sandra Peterson, director of physician practice's patient accounting services. "It was that old."

Peterson says the field of vendors was narrowed to three. The organization selected a system from Lanier because the company had a background in health care that the others didn't.

The initial cost of the system, Peterson estimates, was between $250,000 and $300,000, including all the software and installation, and there have been upgrades since.

The ONLINE system was installed in August 1995 and it was up and running by January 1996.

The system is used to record "charge tickets," showing the services doctors provided to patients, as well as documenting patient signatures on those documents. But the system is mostly used for storing explanations of benefits (EOBs) for insurance purposes.

The documents are usually retrieved when a patient questions a charge, "especially when something appears to be billed in error," she says. "Usually a charge ticket will be pulled for verification.

"Beyond killing the costs for microfilm development services, the system has improved the efficiency of everybody," Peterson says. That is in keeping with the original plan, which was to improve employee efficiency, not reduce staff.

Lanier's ONLINE system allows multiple documents to be displayed simultaneously, supports scanned images, COLD pages and third-party documents.

Because the need to pull information from stored disks turned out to be minimal, the practice didn't need a larger juke box.

"We also have a single disk drive that we use to pull information from stored disks," she says. "It works well for us."

Quest Diagnostics: 2 years, 5,000,000 scans, 0 major failures

For more than five years IS Manager Relta Roback had been looking for a better way to maintain document records at Corning's Auburn Hills, Mich., lab.

Unfortunately for Roback and the lab (which recently changed its name to Quest Diagnostics), was still developing and, in any case, was out of the lab's price range.

Her search ended two years ago when she agreed to work with Freedom Business Machines, Ann Arbor, Mich., on developing a document imaging system tailored to the needs of the lab.

The key components in the system include two Bell & Howell 2138-A scanners that can scan up to 72 pages per minute; a Hewlett Packard SURSTORE 100 ST juke box holding 72 platters totaling 100GB; and Digital servers.

"5o far, five million scans have been made on one Bell & Howell scanner in two years with no major failure." says Bob Wolff, president of Freedom Business Machines.

After initial adjustments to the document feeder as well as better software for storing images on CDs, the lab is now scanning between 13,000 and 16,000 requisitions per day.

"They often have attachments so they usually could be as high as 18,000 to 19,000 pages" Roback adds.

The system works like this: "As soon as the order is processed B entered into the laboratory information system A it is imaged," she says. "In the process of accessioning (doing order entry), the order is assigned a number and a bar-coded label is attached to the paper that we want to scan. When we scan the paper, the imaging system reads the bar code so the image is retrievable by typing in the accession number."

Each image is kept on-line in the lab's information system for about 90 days. Then they are transferred to CD-ROM. A database on the network that stores the image's accession number will also give the CD number if it has been filed.

"With the new system, paper never leaves the office," she explains. The image is available for the customer service department as well as the billing department if they have to go back to the original for questions about lab requests.

"One of my peers was looking at our imaging systems," Roback says. "When we went into the client services office, he could not believe ali customer service representatives had a scanned image pulled up on their computer screen while talking to customers."

Roback says the system "probably paid for itself in about a year with the elimination of microfiche as well as improved customer service, regarding immediate access to image.

Wolff estimates that the microfiche system was costing the lab about $250,000 per year to maintain. The image scanning system was implemented three years ago at a cost of $200,000, he says.

COPYRIGHT 1997 Nelson Publishing
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