Scan Patient Records — Stat

Time is of the essence on most IT projects, but some deadlines are more extreme than others. For example, imagine that you have millions of business records stored in a facility that will soon be demolished and you must digitize all of the documents in a hurry or lose them forever. How would you handle that pressure? Well, this hypothetical scenario was all too real for Wyoming Medical Center (WMC), and it responded by investing in a new high-speed document scanning solution.

DATED SCANNING HARDWARE IMPEDES PRODUCTIVITY
WMC is a regional 205-bed hospital and level II trauma center. The hospital stored 13 million pages of patient files in a records room located directly under a parking garage that was slated for destruction in 18 months as part of a new building project. No other space at WMC was substantial enough to support the physical documents, so the hospital decided that imaging the files was the best way to vacate the storage facility while preserving the documents.

Document imaging was nothing new to WMC. The institution had a scanning solution in place for a number of years that consisted of three FTEs (full-time employees) imaging patient records into WMC's Horizon Patient Folder (HPF) system using three production-level document scanners. However, this system was primarily focused on getting new patient records into HPF and was used to image the hospital's stored records as a secondary objective. Furthermore, this solution was only capable of imaging a maximum of 10,000 to 12,000 documents per day, which created a bit of a problem for WMC.

"With 13 million pages of back files in our medical records room, we calculated that it would take us eight years to scan all the documents in our medical records room using our existing system — and that was with the help of two to three temps," says Nick Belveal, director of HIMS (health information management systems). "We only had 18 months to get the job done, so we had to find a way to speed up the process."

One of the limitations of WMC's prior imaging solution was the rated scanning speed of the three production-level devices the company used. However, Belveal points out several other factors that further impeded the productivity of this platform:
Extensive document preparation — The production scanners in use at WMC could only scan 8.5-by-11-inch documents effectively. When smaller documents were present in a patient file (e.g. lab notes, prescription slips, etc.), they had to be taped to an 8.5-by-11-inch sheet of paper before they could be scanned.

Single batch scanning — WMC's former scanning solution was only able to batch scan one patient folder at a time. Plus, for each folder, a scanner operator was forced to enter five or six fields to identify the batch type (e.g. inpatient, outpatient, discharge, etc.) and patient record.

Document double feeds and skews — The existing scanners often accidentally fed multiple pages through the device at once. As a result, certain pages weren't properly imaged or imaged at all. Furthermore, images that were captured were often skewed or upside down. Scanner operators were forced to look page by page at each image after the scanning process occurred to ensure that all pages in the file were scanned and in the correct orientation. The operator would then index the document image and enter it into HPF. This highly manual process added countless hours to image indexing. In fact, using this platform, Belveal states that operators spent 70% of their time indexing, 22% of their time preparing documents for scanning, and only 8% of their time actually scanning documents.

OUTSOURCING ISN'T ALWAYS THE ANSWER
Since WMC couldn't scan all its patient records in time using its existing solution, two other options remained — it could outsource the project to a service bureau, or it could upgrade its in-house imaging solution. While outsourcing had the advantage of limiting WMC's upfront capital expenditure, Belveal was leery of going this route due to a bad prior experience with outsourcing.

"As medical records director for another hospital, I decided to send our patient EOB [explanation of benefit] forms to a service bureau for scanning to save our clerks time in their file retrieval and data redaction activities," he says. "The service bureau had two college kids perform the scanning over one summer, and their work was careless. Documents weren't indexed correctly, and some documents were scanned into the wrong patient records. Not only were the indexed images they sent back to us screwed up, but the original paper files were returned out of order as well. Fixing their mistakes took more time than if we just did the project ourselves. This experience helped me realize how important it is to maintain control of your documents on projects like this."

To learn how another healthcare facility is benefiting from document imaging technologies, visit www.ISMinfo.com/jp/5867.

Maintaining document control meant upgrading WMC's in-house document imaging system. Belveal began his search for a new solution at an AHIMA (American Health Information Management Association) exposition in 2007. There, he visited the booth of Imaging Business Machines, LLC (IBML) and was introduced to the ImageTrac III high-speed document scanner. With scanning speeds of 257 ppm (pages per minute), Belveal was initially intrigued by how fast the ImageTrac III was able to image documents. However, upon further investigation, it was the scanner's ultrasonic multifeed detection capabilities and open track design that ultimately sold Belveal on the ImageTrac III (see sidebar).

After familiarizing itself with the capabilities of the ImageTrac III, WMC next performed a cost/benefit analysis to determine whether or not an investment in the device was sound. WMC assessed the productivity of its current scanning platform and weighed this against the expected productivity of the ImageTrac III. The ImageTrac projections were based on the statistics and results other companies had realized from the scanner. This analysis indicated that an investment in an ImageTrac III would pay for itself in the first two years as a result of reduced labor costs and save WMC another $350,000 over a five-year period.

BEAT DEADLINES WITH SCANNING SPEED AND PROCESS AUTOMATION
WMC began implementing the new ImageTrac III solution in May 2008, and the process took two months to complete. End user training was provided by IBML over a two-week span, and WMC employees adapted quickly to the new solution.
"Our imaging operators were already familiar with the general document scanning process, which sped up the learning curve," says Belveal. "They only had to learn how to use a new device and modify their processes. They didn't have to learn the scanning process from scratch."

Once the solution was up and running, WMC tested the limits of its new system by holding a "Scan Week" event. For one week, WMC ran its new document imaging solution 24/7 to see how many pages of medical records it could scan within that time window.
"We scanned and indexed approximately 468,000 pages, equaling about 13,000 jobs, during the 'Scan Week' exercise," says Belveal. "With this document throughput, we realized we could image all 13 million pages stored in our records room in just six months if we had to."

WMC doesn't normally operate its new scanning solution 24/7, and the company quickly realized it wouldn't need to. Even during normal operating hours, the ImageTrac III solution is nearly five times as productive as WMC's previous scanning system. "We used to only be able to image 10,000 to 12,000 documents a day, but we can now scan and index approximately 52,000 pages a day with our new imaging solution," says Belveal.

What's more is WMC has enjoyed this productivity increase with fewer FTEs contributing to the process. "We used to have three FTEs dedicated to the scanning process, and we thought we were going to have to hire two to three additional temps to scan all our medical records before our records room was demolished," adds Belveal. "However, we were actually able to increase our productivity while cutting our FTE requirements by 33%. Plus, we no longer require the temps we thought would be necessary."

The productivity gains WMC is enjoying are due to much more than the mere speed of the ImageTrac III. Belveal points out several other factors of the new solution that are contributing to the solution's success:

Reduced document preparation — WMC's new ImageTrac III solution can scan documents of multiple sizes and thicknesses in a single pass. Scanner operators no longer need to tape smaller documents to an 8.5-by-11-inch sheet of paper. This reduces the amount of time WMC employees spend on document preparation tasks.

Multibatch scanning — With the ImageTrac III solution, WMC can scan multiple batches at once by using purple bar-coded separator sheets to distinguish one record from the next. Operators are no longer required to enter five or six fields to identify the batch and patient record for each folder. Instead, this information is represented by different bar codes on the separator sheet and uploaded to the system automatically.

Automatic document orientation and multifeed detection — With ultrasonic multifeed detection, the scanning belt on the ImageTrac III automatically stops whenever a doublefeed is detected. This feature ensures that all pages are scanned, meaning operators no longer need to do a post-scan quality check of the images to ensure all information is accounted for. Furthermore, an autorotation feature on the ImageTrac III automatically deskews document images and ensures images are presented in the correct orientation. Both of these features have streamlined WMC's indexing processes.

WMC has currently scanned approximately 1/5 of the 13 million pages of patient files in its records room and is on pace to complete the project within the 18-month time window originally outlined. However, the parking garage slated for demolition has been granted a stay of execution because the struggling economy caused WMC to place the building project on hold. Nevertheless, WMC can rest assured that its new scanning solution is well-suited to handle not only this project, but also any other scanning emergency the company may face.