Technology focus: Document imaging systems

Technology focus: Document imaging systems

It's rare that a single technology can reduce expenses, help deliver better care, decrease the time patients spend in hospitals, and save time for healthcare professionals.

But document imaging systems can do all that, say consultants, vendors, and users of such systems. Converting paper documents to electronic images, they say, not only offers the obvious benefits but can transform a healthcare facility's workflow and help change the way it does business and interacts with patients.

"There are benefits and savings almost everywhere you look," says Richard Howe, vice president for IT consulting for VHA Inc., a nationwide cooperative that serves 2,200 not-for-profit healthcare organizations. "We've seen organizations reduce medical records staff and billing staff by 15 percent; a hospital save US$200,000 a year in warehouse storage costs; and improvements in patient safety, the speed of care, and a speed-up in accounts receivable."

In a typical document imaging system, paper documents such as informed consent forms, HIPAA forms, referral authorization forms, and patient charts are scanned and turned into images. Those images are then linked to a patient's computerized medical records so they can be called up instantly. Paper-based records, on the other hand, require physical space and are available from only that single location.

Some document imaging systems also include optical character recognition (OCR), so some text records can be scanned and turned into electronic records rather than images. Images are mere copies of the original, but available electronically. Electronic records, on the other hand, are live data that can be altered, searched through, and used in databases and medical records systems.

Naomi Miller, director of product marketing for Documentum, which sells document management solutions, adds that the real payback for document imaging comes when it is combined with a content management system so that manual paperwork processes can be automated.

Healthcare organizations moving to document imaging systems sometimes find that benefits go beyond what was initially anticipated. That is what happened to DCH Health System, a Tuscaloosa, Ala.-based provider of community health services that operates four hospitals.

Kim J. Ligon, director/CIO for information services, says DCH has been using document imaging for five years, using MedPlus ChartMaxx for medical records and MedPlus OptiMaxx for nonmedical records. Paper required too much space, and microfilm was inefficient.

Document imaging solved the storage space problem, but had other even more significant benefits, Ligon says. "It also had built-in workflow," she says, "which makes the entire process of patient care far more efficient. For example, physicians can sign out a patient more quickly, because all records and charts are available electronically. So rather than wait for another doctor to finish examining a paper chart, the physician can see the digitized chart, and sign off then -- even if he's at home or in a different hospital."

With four main locations, sharing is particularly useful for DCH, as images, lab reports, charts, physicians notes, and other information do not have to trail patients from office to office and hospital to hospital, as with paper.

Cutting Down on Paper

The Hudson Health Plan, serving Medicaid and other state-assisted insurance plan members in New York's Hudson Valley, uses document imaging to speed up the processing and renewal of benefits. Government plans require many documents, such as birth certificates, tax returns, and utility bills, all of which must be submitted and updated annually. A single Medicaid file is an inch thick.

Toni Bonde, vice president for managed care, information systems, notes that the plan is located in Westchester County, where real estate is at a premium, so eliminating space needed for storage was a money-saver. The space occupied by 35 large file cabinets could be used for other purposes.

And it made for better care: Someone handling a patient's case can quickly bring up all the patient's records rather than manually searching for them. Linda Bilek, senior project manager in the IS program office of the Honolulu-based Hawaii Medical Service Association (HMSA), the largest provider of healthcare coverage in Hawaii, found similar benefits.

HMSA uses the Documentum ECM platform for content management, which is tied into scanning systems. It began using document imaging two years ago, first in the enrollment department and then the claims department. Enrollment and claims information can be brought up immediately from a patient's record without searching through paper. In addition, HMSA has expanded its scanning solution so that it also does OCR in the claims department, meaning that records can be created as electronic documents, not just images.

VHA's Howe estimates that 50 percent of healthcare institutions use some form of document imaging today, although he expects that number to increase. Why? "Document imaging systems have one of the highest ROIs of any IT system, because they attack workflow and labor directly," he contends.

Regardless of benefits, some physicians will never move to the electronic world. "I just don't have the time or money to scan everything in," says a physician who is just a few years from retirement. At the same time, he acknowledged the need to do it, even though he does not have the wherewithal to carry out such a move.

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