According to a 2007 end user survey conducted by AIIM — The Enterprise Content Management Association, the two biggest drivers for enterprise content management (ECM) technology adoption are to improve productivity (74%) and to comply with industry or government regulations (26%). Memorial Hermann Healthcare System (MHHS) is no stranger to either of these drivers. In 2002, the organization implemented a Sovera HIM (health information management) solution in an effort to ensure compliance with HIPAA (Health Insurance Portability and Accountability Act) requirements. At the same time, MHHS also established a centralized scanning department charged with imaging patient documents into Sovera in an effort to establish a complete electronic medical record (EMR) for every patient. This initiative was spurred by President Bush's call for the widespread adoption of universal EMRs by the year 2012. In each of these instances, a great deal of attention was also dedicated to how these systems could help increase staff productivity, reduce operating costs, improve patient service, and help provide MHHS with a technical advantage over regional competitors. These familiar compliance and productivity drivers were also central in MHHS' latest technology decision to completely overhaul its centralized scanning infrastructure.
AN INCREASE IN DOCUMENT VOLUMES REQUIRES A NEW SCANNING INFRASTRUCTURE
When MHHS first established its centralized scanning facility in its corporate headquarters in Houston, it only imaged outpatient and recurring patient records, leaving the inpatient records in a paper-based form. This scanning strategy was in line with MHHS' internal schedule for EMR compliance. "Inpatient records often include a lot more nurse and physician documentation than outpatient and recurring records," says Patricia Tooley, assistant executive for MHHS. "Before we started imaging inpatient records, we wanted to limit the amount of documentation included in these files by maximizing use of other features of our EMR solution, such as electronic verbal lab orders and patient progress dictation."
Sixteen employees using six midvolume scanners were required to image the outpatient and recurring patient records, which totaled about 700,000 records per year. Though MHHS was scanning large volumes of documentation, it was still left with an incomplete EMR due to the absence of the paper inpatient record. Finally, in late 2006, the decision was made to add inpatient charts to the imaging workflow. While this decision would have a positive impact on MHHS' EMR progress, it posed a significant challenge for the centralized scanning staff. For example, the abrupt introduction of inpatient records would add nearly 200,000 patient records (averaging 130 pages in length each) to the annual scanning workflow. Furthermore, MHHS' centralized scanning department was held to meeting a maximum imaging turnaround time of 24 hours to scan each patient record that entered the facility. "According to my calculations, to meet these deadlines using our existing scanning infrastructure would require a minimum of three additional midvolume scanners and 10 additional full-time employees (FTEs)," says Tooley. "It was evident that this was going to be a costly investment over time, so we decided to consider changes in our scanning technology platform as a potential alternative."
ON-SITE VISITS REVEAL SUCCESSFUL IMAGING PRACTICES
MHHS turned to CGI Group, Inc., the solutions provider that supplied MHHS with its Sovera HIM system as well as its initial centralized scanning infrastructure, to help in the search for a new solution. CGI realized that a significant upgrade in scanning speed and throughput would be necessary to make an infrastructure change viable. The solutions provider had recently deployed ImageTrac IV scanners by Imaging Business Machines LLC (IBML) (see sidebar below) for a state government client with intense document volumes and believed the platform could help MHHS handle the new influx of inpatient records.
CGI presented the ImageTrac IV option, and MHHS' interest was piqued. The next step was to see the ImageTrac IV scanners in action in a real-world environment. CGI arranged for members of MHHS' centralized scanning department to visit a nearby existing IBML customer — EDCO, a document scanning and conversion services company. While EDCO is not in the healthcare industry, the visit allowed MHHS to witness the capabilities of the scanning hardware and, more important, observe the processes EDCO put in place to streamline the document scanning workflow with the ImageTrac IV platform.
"The IBML platform was much different from the scanners we were already using," says Lisa Coleman, director of centralized scanning for MHHS. "Each ImageTrac scanner was about 10 feet in length, and multiple employees were simultaneously involved in the scanning process — from the time documents are prepped prior to imaging to the time scanned documents are boxed for warehouse storage. Scanning efficiently on these devices is much like setting up a manufacturing assembly line. We used an on-site visit to see what scanning processes were successful for other companies and modified and improved upon these practices. In the end, we took a lot of good process ideas away from the EDCO site visit." Practices that MHHS emulated as a result of the site visit include using a document box marked with tape to measure the scanning productivity of each employee and using conveyor belts to transport documents to and from the scanners.
Following the site visit, MHHS was ready to invest in a new scanning infrastructure based on the ImageTrac IV platform. However, MHHS knew that transitioning its centralized scanning staff to an entirely new imaging environment wouldn't happen overnight. CGI and IBML worked closely with MHHS to provide scanning employees with a two-week course of hands-on training before moving patient records over to the new system. Throughout the implementation and training process, MHHS continued to operate its existing scanning infrastructure to ensure its imaging operations never shut down or fell behind.
INCREASED SCANNER THROUGHPUT DECREASES LABOR NEEDS
MHHS' new centralized scanning infrastructure consists of two IBML ImageTrac IVs integrated with Datacap Taskmaster software. The move from six scanners to two scanners has helped MHHS shift many of its centralized scanning employees away from scanning and into other areas of the capture process, such as chart check-in, document preparation, and quality control.
With the new system, patient records are prepped for scanning (i.e. staples and paper clips are removed, bar coded patient labels or separator sheets are inserted for automatic document identification and data extraction) by each regional facility. These records are then sent to MHHS' centralized scanning facility, where employees first perform a quality check on the prepped documents. These employees will insert any missing labels or separator sheets and affix a cover sheet to each batch denoting the type of batch and the facility location. Batches are then delivered to the scanning station for imaging. Once there, a scanner operator images the document batches on an ImageTrac IV. As each document is imaged, key information (e.g. document type, location code, account number, etc.) is extracted off the paper documents, converted into digital images, and sent to the Datacap Taskmaster application. Datacap background programs perform various tasks such as image cleanup, OCR (optical character recognition), validation algorithms, and data cross-referencing with MHHS' Sovera databases. If any problems arise during these processes, MHHS employees are able to correct errors or fill in incomplete information, as well as view the quality of each scanned image. Once an MHHS employee verifies that a quality image has been captured and that it has been properly indexed, the image is then stored within the Sovera HIM system and available for retrieval throughout the MHHS network. After the batches are scanned, they are transported (via conveyor belt) to a warehouse where they are stored for six months and then destroyed.
The complete overhaul of its centralized scanning facility was a mid-six-figure investment for MHHS, but the organization believes it will receive full payback on the solution in as little as 18 months. Cost savings from the system come mainly from being able to control labor costs. "With scanning speeds of more than 380 ppm [pages per minute] and the ability to scan hundreds of batches per day per device, we are getting a much better document throughput from the ImageTrac IV platform," says Tooley. "The throughput of our new document scanning solution has allowed us to handle the influx of inpatient records without hiring a single additional FTE. In essence, moving to a new platform kept us from having to hire the 10 FTEs that would have been necessary using our old scanning model."
Productivity gains have also been enhanced by some of the scanning processes MHHS put in place. For example, the conveyor belt model MHHS emulated from the site visit prevents employees from having to carry heavy boxes of records and gets documents through the scanning workflow at a faster pace. These added productivity measures, when combined with the throughput of the scanner, are allowing MHHS to image patient records within 8 hours of receipt — crushing the mandated deadline of 24 hours and putting the company on a fast path to creating universal health records for all its patients.