Data Migration When and How

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Data Migration When and How
June 24, 2005 Speaker Joyce Graham President,
MedaSuite Joyce.Graham_at_MedaSuite.com
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Agenda

• Going Paperless
• Where are we today?
• What difference will it make?
• Data Migration of existing charts
• Keep paper, i.e. age and archive?
• Scan into system?
• Manual Data Entry?
• Day Forward Incoming Paper
• Can you turn it off?
• Do you want to?
• Data entry choices
• What will it cost and how will it change my
  practice?

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Establishing a Baseline

• Data Migration of Paper Charts to EMR

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Where are we today?

• Creating, handling, searching for and through
  paper generally accounts for 30 of labor
  cost in manual processes.
• 300 to 400 per physician per month in materials
  costs, dependent on practice type, e.g.
  Pediatricians will edge above 500
• Adopting an EMR without migrating data
• Initially creates a 50 increase in labor
• Gradual manual migration of data
  6 months to 2 years
• Scan in or manual entry by office personnel
  (overtime)
• Increase in efficiency after data is migrated
• Imaging provider 1 to 2 weeks

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Paper materials costs in a 4-Physician Practice
Additional Costs Include file cabinets, paper
storage systems, off-site storage
Materials
Per Day Cost
/ unit Total / month
Monthly Materials Savings/Cost
363.71/physician
1,454.83
Monthly Rent Cost to keep Paper Records
Monthly Rent Savings / Cost
625.00
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Medical Labor costs for paper charts in a
4-Physician Practice
Medical Labor Costs for Charts
Per Day Minutes Min/ Mon
Non-Visit chart pulls are for refills, lab
results, phone consultations, and
correspondence. National Average is 60 of total
patient visits.
Administrative Overhead is calculated at
30 Average Wage of Support Staff at 14/hr
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Labor costs associated with paper in a
4-Physician Practice

• Lead Physician Chart review
• Drug Recalls
• Scheduling
• Billing and Office Management
• Filing and pulling charts for billing
• Finding Superbills
• Calls regarding patient statements
• Insurance Audit Preparation
• Compliance reporting

Expect 25 to 30 reduction in labor costs
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Keep Paperi.e. age and archive?

• Practices report a 50 drop in productivity if
  they do not bring in any of the information from
  the paper charts
• Removing paper from a process historically
  provides a 30 increase in efficiency
• HIPAAs claims for savings are based on removal
  of paper, i.e. moving to electronic information
  systems

No! Get rid of the paper!
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Data Migration of Existing ChartsWhich and How
Much?

• Which charts? All active and inactive? All
  active?
• The answer is Actives Only!
• Scan in charts of inactive patients as/ if they
  return
• Whole chart? Current volume? 'transition visit'
  template?
• Transition Visit Template If you dont get rid
  of the paper you will not achieve the savings
• Minimums Scan Current volume, keeping
  additional volumes on site
• If multiple volumes are less than 15 of total
  records then scan all Actives and get rid of the
  paper!

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Data Migration of Existing ChartsScanning
Medical Charts

• Do it yourself or Hire the Pros?
• How big is it?
• 1900 patients/ physician X 4 Physicians X 50
  pages 380,000 pages/images
• 1,280 hours of Imaging Professionals 10 days X 2
  shifts/day X 8 hours/day X 8 people per shift.
• Setup, demographics entry, and indexing
• Special software and equipment
• Internal 6 months to 2 year catch-up. Costs
  much more than outsourcing.

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Data Migration of Existing Charts

• Before you start scanning
• Is your EMR vendor willing to provide technical
  personnel to work with the imaging vendor?
• Hourly rate or fixed price?
• Who will be accountable for end result?
• EMR or Imaging?
• There must be a Project Manager
• Sign BAA w/ company performing imaging
• Evaluation of charts for pricing
• Not to exceed bid
• Document with vendors how scanned images will be
  stored in EMR (indexing or categories)
• Test run on a sample set and approve results
• Arrange scanning hours and location (7x24?
  On-site? Off-site?)

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Data Migration of Existing ChartsHow?

• Demographics
• Extract patient demographics from current billing
  system
• Enter demographics into EMR database using a
  software script
• Manual Data Entry
• Current meds and allergies
• Problem list
• Lab dates

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Data Migration Questions

• Quality of Scanned Images
• As good or better quality than original
• Better on thermal faxes than original
• Optical Character Recognition (OCR)
• Dont expect handwriting recognition
• Wont recognize logos
• Recognize most typed information
• Titles of Forms if text based, e.g. SOAP, Growth
  Chart, Dates
• Will create indexes of recognized typed
  information
• Will not always be correct when recognized
• Will not recognize everything it should
• Marginal cost increase and Marginal results
• What do you do with the paper once youre
  through? Have responsibilities changed?
• You may archive the paper copies of active
  records once you have them in your EMR
• Dont destroy them! You still have custodial and
  defense requirements
• Once you create it you have to keep it and be
  responsible for it.

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Day Forward Incoming PaperCan you Turn it off?

• Yes
• Faxes Electronic fax queue
• Most labs have digital interfaces the others
  will fax them
• Most billing information if integrated with EMR
  and SuperBill
• Digital Signature pads for permission and consent
  forms
• Electronic Prescription modules handle new
  prescriptions and refills
• Maybe
• Patient Transfers, consults
• If they will fax them to you
• Referrals If faxed or entered via EMR
• Patient information sheets
• Patient kiosk
• Entered into EMR by MA or Front Office
• No or probably not x-rays, MRIs,
• Most practices dont keep the film do you
  really want them?
• Special interfaces required not widely supported
• You can keep it, but it takes up a lot of data
  storage
• Additional hard drives or electronic storage
  media
• Significantly increases data backup costs

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Day Forward

• Turning Off the Paper Stream

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Day Forward Incoming PaperDo you want to turn
it off?

• YES!
• Cost
• Its that 30 again!
• Liability
• Less or no loss
• Tracking and record of receipt and transmission
• Automated compliance capture
• Patient Safety
• Digital data is legible, findable, trackable

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What will it cost?Example 4-Provider Practice

• Outsourced EMR and Imaging Provider not
  integrated
• Imaging 40,000 to 70,000
• Populate EMR database 15,000 to 30,000
• Demographics Information 7,000 to 15,000
• Outsourced EMR and Imaging Provider Integrated
• Imaging 30,000 to 50,000
• Populate EMR database automated and included
• Demographics Information 5,000 to 10,000
• Do it yourself
• Imaging (All Actives) 120,000 to 240,000
• Populate EMR database 40,000 to 120,000
• Why so much more?
• It will take significantly more labor
• Software and scanners of imaging companies are
  very expensive
• Hourly costs for your staff are higher than their
  hourly costs
• Plus you will not realize efficiencies until the
  paper is gone
• Delayed savings

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How Will It Change My Practice?

• RRHC Case Study
• 33 increase in patient throughput
• 2,000/month in reduced office rent
• Reduced office hours
• Before 715 to 615pm
• After 830 AM to 5pm
• Reduced staff requirements
• Reduced materials costs

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Medical Records Solutions
from
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Supplementary Materials
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Where are we today?Medical Records
Electronic
Paper

• 3/chart for materials cost
• Labor intensive
• 5 to 7 per chart pulled
• Telephone tag with pharmacy
• 1 to 5 minutes to find info
• Floor space for file cabinets
• Only one person can access at a time
• Not secure
• Lack documentation to support maximized billing
• Legibility

• No materials cost
• Significantly reduces labor
• No lost charts
• 10 seconds or less to find info
• No file cabinets
• Multiple users access at same time
• Secure authorize and track access
• Improved documentation
• No legibility problems
• Improves patient safety
• Electronic tickler system
• Electronic alerts
• Remote access

Source Healthcare Information and Management
Systems Society
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Where are we today?Prescriptions
Electronic
Paper

• 30 renewals/day/primary care physician
• 80 of nurses time - 15 minutes / script
• 5 to 7 per chart pulled
• Average 5.5 call backs per new script
• Illegible handwriting
• Not covered by patients insurance
• Conflicts with other medications
• Improper dosage
• Lost faxes and lost phone messages.
• 34 error rate in handwritten prescriptions
• Prescription errors constitute 50 of all medical
  errors
• 2006 1st mandate of 2003 Medicare Modernization
  Act - transition to electronic prescribing

• Single click refills
• Electronic chart pull (5 seconds)
• Virtually eliminates call backs
• Legible
• Auto alerts for non-covered Rxs
• Alternative Rxs to non-covered
• Alerts
• Drug interactions
• Allergies
• Dosing
• Drug information for prescribers
• Print handouts for patients
• 4 electronic error rate
• Drug usage reporting
• For recalls and patient notification
• Medical studies

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Where are we today?Scheduling
Electronic
Paper

• Labor intensive
• Find patients appointment
• Find open slots
• Tracking no-shows and cancellations
• Not effective to schedule wait-list patients to
  fill cancelled slots
• Cannot track health maintenance

• Instantly find
• Patients scheduled appointment
• Appointment availability
• Track no-shows and cancellations
• Productivity and utilization reports
• Alerts
• Health maintenance visits
• High risk patients
• Patient balances
• Insurance coverage

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Where are we today?Billing
Integrated with EMR/EPM
Current Billing Services

• Paper billing
• Hand coding
• Delay mail / courier to billing company
• Cant check for missing or incorrect info
• 60 days 5/claim
• Manual verification of insurance
• Billing Service
• Assisted Coding
• On-line submission of claims
• Real-time claim status and tracking
• Checks for errors and missing info
• 14 days .25 to .30 per claim
• Patient eligibility
• Fewer billing personnel

• Billing Service benefits
• plus
• Superbills
• Never lost
• Automated tracking
• Auto-populate to claim
• No re-entry
• Documentation supports maximized billing
• Customized reporting capabilities
• Support RHC, FQHC requirements
• Grant qualification
• Facilitates audits

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Where are we today?OM and Information Access
Integrated with EMR/EPM
Currently

• Information Access
• Only one person at a time can have the paper
• Difficult to share with outside providers and
  between sites
• Difficult to track and comply with regulations
• Not secure

• Information Access
• Multiple staff can view charts at the same time
• Easy to share
• Automated tracking and compliance reporting
• Highly secure