Document Imaging and the Benefits to Workflow

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Document Imaging and the Benefits to Workflow

• Christine Rys, RHIA

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Progress of the EHR

• One system access
• Multiple system access

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Efficiency of an EHR

• Economic benefits
• Productivity improvements
• Access to clinical information
• Improved/enhanced documentation

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Challenges of the EHR

• Provide a complete history to clinicians
• Provide complete information to requestors (ROI)
• Cost associated with juggling a hybrid record
  (i.e. FTEs, lawsuits, etc.)

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Benefits of Document Imaging

• No paper to file and retrieve Electronic
  Fileroom
• No need for purging, microfilming or off-site
  storage
• Easily duplicated and backed up
• Eliminate all paper-record related costs
• Instant, simultaneous, secure access for all
  users
• Electronically perform record-related tasks
  such as coding management, ROI, audits, etc.

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Suggested Paths

• Day forward
• Back scanning

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Evaluate Day Forward Scanning

• Pros
• Immediate access
• No electronic archival costs
• Disaster Recovery

• Cons
• No benefits for release of information
• Physician buy-in delayed
• Hybrid record
• FTEs to locate paper record

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Day Forward Example

• 600 bed facility
• Began project with June 1 discharges and move
  forward only.
• View prior records via another imaging system,
  some on film, some hardcopy

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Evaluate Back Scanning

• Pros
• Complete electronic record
• Access from multiple workstations
• Eliminate paper related tasks
• Disaster Recovery

• Cons
• Cost prohibitive
• Labor intensive
• Potential indexing issues

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Back Scanning Example

• Decrease in on-site storage
• Increased process time for producing microfilm
  for active records (filming out previous year)
• Significant number of lost/missing records due to
  fragmented storage
• Increase to monthly purges
• Additional Tasks
• Transfers
• Printing from other systems
• Centralization of Off-site Storage Processing to
  HIM

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Alternative Solutions

• Two small hospital scenarios
• Hospital 1
• Scanning day forward on-site and pulling and
  re-activating permanent record
• Decreasing the file room while the patients
  revisit and allow the history and current visit
  available electronically
• Hospital 2
• In 2006 chose to back scan all 2005 records for a
  comfort level with a vendor off-site
• In 2007 chose to back scan all 2006 records
  off-site
• In 2008 will begin day forward scanning on-site
  and then bridging the gap with the 2007 records
  on-site

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Document Imaging Choices

• Do it yourself
• Outsource

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Do it yourself

• Disrupts record management processes
• Backlogs in scanning, coding and ROI
• Need to learn how to design, implement and
  maintain the operation
• People must be hired, trained, managed and
  retained
• Ongoing personnel costs are almost always
  substantially underestimated
• Capital investment for equipment plus maintenance
  costs

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Outsource

• Total Solution
• Scanning software
• Scanning service
• Retrieval and Viewing Software
• Hardware
• Maintenance
• Experience and Expertise
• Integration with the EHR
• Provide both on-site and off-site services
• Available and flexible
• HIPAA supportive

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Trends in the Industry

• Best of Breed
• Purchase the best software for HIS, the best
  software for scanning, etc.
• Best Fit
• Purchase one HIS software and all of its
  components

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Process Flow of the Medical Record

• Registration (admission forms, etc)
• Transcription/Dictation
• Discharge
• Assembly
• Analysis/Record Completion
• Coding
• Abstracting
• Reviews, audits
• External Reporting
• Release of Information
• Retention

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Registration

• Scan Admission forms
• Insurance cards
• Drivers license
• Consent forms
• Advance Beneficiary Notice
• Advance Directives
• Photos (identify theft)

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Dictation

• Scan or COLD Feed?
• History and Physical Exam
• Consults
• Operative Reports
• Discharge Summary
• Diagnostic Reports

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Post-Discharge Assembly

• Bar code documents, Character recognition, Form
  recognition for placement in record
• Bar code should contain
• Patient name
• MR
• Account
• Date of Service
• Document ID

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Post Discharge Chart Completion

• Record Analysis/Completion
• Online analysis
• Distribute work equally amongst analysts
• Electronic Signature
• True electronic or Digital?
• Monitor productivity of analyst
• Monitor turnaround time of chart completion
• Monitor volume of deficient records
• Loose sheets/Late reports

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Post Discharge Coding

• Distribute work based on record type, employees,
  hours work, etc.
• Monitor productivity daily, monthly, weekly
• Communicate with physicians
• Attach electronic notes
• Email coding questions to peers, supervisor

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Release of Information

• Electronic retrieval
• Multiple delivery methods e-mail, CD/DVD,
  upload, electronic view via secure web
  server/portal

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Permanent Storage

• Audits
• Internal/External Reviews
• External Reporting
• Research
• Retention

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Decisions

• Unique situations
• Analyze all options
• Choose wisely

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Questions????
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THANK YOU!!!!!

• Sources
• Electronic Health Records, Third Edition, Margret
  K. Amatayakul, AHIMA publication, 2007
• Electronic Document Management as a Component of
  the Electronic Health Record, AHIMA e-HIM Work
  Group, October, 2003
• Document Imaging as a Bridge to the EHR, AHIMA
  Practice Brief, 2003