Although the doctors’ attention is devoted to delivering excellent patient care, they recognize that if the medical group’s finances aren’t in order, their ability to continue serving patients is compromised. Therefore, they’ve charged their business office with employing the best people, processes and technology to optimize the revenue cycle and ensure the profitability of the practice.

Recession Brings Reimbursement Challenges

“The tough economy and changing California regulations have made it more and more difficult to collect payment in a timely manner,” explains Sue Kruger, Office Manager at Tri City. “Medicare and Medi-Cal pay only a fraction of the fee for emergency services, people who’ve lost their jobs and their health insurance oftentimes can’t pay for their care and private payers sometimes drag their heels.”

She notes that the group’s physicians treat an average of 6,000-7,000 patients a month. In terms of Tri City’s revenue:

• 27% comes from Medicare patients.
• 17-18% comes from Medi-Cal.
• A little over half comes from private insurers and self-pay accounts.

“Our employees have to work much harder to collect the same percentage of payment they did three or four years ago,” says Kruger. “If we didn’t have a paperless system, we’d absolutely have had to hire more staff.”

Integrating Content Management with Practice Management

After transitioning to a new practice management system—CPU’s MED/FM—in 2003, Tri City began thinking about how to get even more value out of that system. When CPU introduced an integration with Laserfiche enterprise content management (ECM), Tri City jumped on board.

“Handling paper was a big expense that slowed our staff down,” says Kruger. “Our doctors recognized that purchasing Laserfiche would pay off in terms of staff productivity.”

J.R. Juiliano, Tri City’s IT Manager, explains, “We scan everything that’s related to patient encounters into Laserfiche. This includes demographic information, dictations, EOBs and correspondence from insurance companies.”

He notes that the hospital sends information to the medical group via an FTP site. “In the past, we just printed everything onsite.”

This, of course, was problematic on many levels:

• It was expensive.
• It was difficult to store.
• It was tough to retrieve in a timely manner.

“We have to keep patient information for seven years,” says Juiliano. “We used to rent four storage units at a facility that’s ten miles away. We kept a year’s worth of records onsite in a big filing room, but somebody had to go over to the storage units at least once a week.”

Kruger adds, “Efficient medical billing depends on keeping people in their seats so they can be productive. Manual tasks like retrieving paper records just aren’t the best use of employees’ time.”

Today, Tri City automates the document capture, indexing and filing processes with the following tools:

• Laserfiche Snapshot converts the electronic documents from the hospital’s FTP site into TIFF images and processes them using Laserfiche Quick Fields, a high-volume document capture and processing tool that automatically extracts metadata from the documents and files them in the Laserfiche repository—no printing or scanning required.
• Laserfiche Quick Fields also scans and processes paper EOBs and correspondence from insurance companies. Using optical character recognition (OCR), Quick Fields converts the scanned images into editable and searchable text, extracts metadata and files the documents in the repository.
• Laserfiche Import Agent captures and processes electronic faxes.

Verifiers, coders and payment entry staff work with dual screens, so they’re able to view a document on one screen while performing data entry into MED/FM on the other. With the MED/FM integration, documents are automatically attached to the appropriate patient records in the practice management system. When employees type a number into a specific field in MED/FM, Laserfiche opens the corresponding document. This ensures that employees don’t have to launch Laserfiche or toggle between screens to retrieve the documents they require.

Kruger explains that the integration keeps her staff in their seats. “Laserfiche makes our staff so efficient that we haven’t had to hire more people. In fact, we haven’t even replaced everyone who’s left.”

Visibility = Productivity

Documents—whether scanned or electronically imported—are time-stamped when they enter the Laserfiche repository so that the management team can measure staff productivity. Kruger explains, “If something comes in at eleven but doesn’t get finished until 4:30 pm, I can go to the person and ask, ‘What were you doing for those five and a half hours?’”

Juiliano appreciates how easy it is to run and store reports in Laserfiche. With Laserfiche Audit Trail, a monitoring and reporting tool, Tri City can create summaries of all actions taken on a particular document or record, making it much easier to prove compliance with HIPAA. “We can see who changed what when, where and why,” he explains.

In terms of other types of reports, Juliano says, “We run a lot of reports—collections reports, month-end reports, weekly reports. Even if we don’t run the report in Laserfiche, we store it there, which makes it easy to access and compare historical data with present trends.”

Lisa Newland, Tri City’s Assistant Manager, notes that the group’s RAC audits have gone smoothly thanks to Laserfiche’s instant search-and-retrieval capabilities. “Being able to instantly pull the information the RAC auditors want to see makes life so much easier than digging through filing cabinets or storage boxes.”

All in all, says Kruger, “Laserfiche is a great product. I don’t know how we ever got along without it.”

Rather than implementing separate solutions for the clinical and non-clinical sides of the house, MCCMHS officials recognized that enterprise content management (ECM) would be the most efficient and cost-effective way to answer its document-related challenges.

ECM Supports EHR

MCCMHS’ search brought the organization to Jeff Nelson of Bolt Document Management, a Laserfiche reseller based in Elkhart, IN. “Initially the objective was for the Laserfiche system to act as a bridge between legacy information and future digital content,” Nelson remembers. “At the same time, implementation of Laserfiche allowed MCCMHS to address areas where working with paper was simply inefficient.”

In 2003 Pat Latimer, the former project manager, led the effort to implement a 118-user Laserfiche system in the agency’s centralized scanning bureau. Staff began migrating and adding patient histories and signature forms for use in conjunction with patient records, which were being generated from Avatar by Crystal Reports and then scanned into Laserfiche.

Dave McElfish, Director of Technology, says that although the original idea was for clinical staff to simultaneously access patient information from Laserfiche and the practice management system, “the reality was, even though we purchased Avatar with the idea of integrating it with Laserfiche, when we explored it further, it was going to be cost prohibitive on the Avatar side of the project.”

In the meantime, Laserfiche deployment had been extended to MCCMHS’s HR and finance departments, which likewise began migrating backfiles to ease storage costs and give staff the ability to retrieve information on command. System use has since grown to the point that the Laserfiche repository now houses over 800,000 documents.

More recently, McElfish says clinical staff have once again expressed interest in being able to access to information from Avatar and Laserfiche at the same time, even going so far as to revisit the idea of using Avatar’s add-on imaging module. “After much consideration, our clinical staff felt that would put us no further ahead in our goal for a true, single database to model our EHR from,” McElfish says. “The reality is that Laserfiche is designed to manage unstructured data, so in that respect it’s closer to that single database because we are able to include unstructured data, such as lab reports and doctor’s notes.”

Going Mobile

McElfish adds that MCCMHS has been speaking with Nelson and Bolt to explore ways to simplify and streamline how data is entered and accessed between Avatar and Laserfiche. McElfish says staff is especially encouraged by the release of Laserfiche Mobile, which could be used to grant clinical staff in the field comprehensive access to patient data via Web Access. He says several options are being considered, including taking advantage of the Laserfiche Q3 Promotion to upgrade the agency’s current system to Avante and receive Web Access (which is required to use the Laserfiche Mobile app) for free.

“We know that allowing staff to access information from Laserfiche on iPads in the field would be a huge boost in our productivity,” says McElfish.

An Avante upgrade would provide lot of potential for automation as well. McElfish notes that Nelson and Bolt have recently been discussing implementing distributed capture processes for paperless faxes and digital signatures via virtual rubberstamps, all routed by Workflow through the agency’s central scanning office for oversight.

Looking ahead, he is understandably pragmatic. “Although Laserfiche is not our primary practice management system, it represents a critical and necessary content management tool that complements Avatar.

“We’ll continue to have paper and documents that need signatures, and the simplest, most cost-effective way to incorporate them into our EMR strategy is to use Laserfiche. There are digital signature solutions and other options, but Laserfiche lets us use what we already have,” McElfish adds. “Our goal was and is to have a single database to model our EHR from, and Laserfiche has provided us with the portability and flexibility to move forward with that goal from a solid foundation.”

When Eastmont Towers’ Health Care Administrator Beth Nelsen RN, CHPN, began exploring enterprise content management systems, she soon discovered that “paperless” meant a lot more than just empty file cabinets. “First, we looked at outsourcing to a company that would scan our records onto disks,” remembers Nelsen, “but we were concerned about how we’d be able to use the information once it was digitally stored.”

Not to mention, outsourcing may have gotten rid of the paper—but it created an entirely new set of compliance concerns. Nelsen next began to explore solutions the agency could configure, use and administer in-house.

Quick Fields and Workflow: impressive possibilities

Kathy Gentile of Laserfiche reseller Bishop Business Equipment had worked with Eastmont Towers as an MFP hardware provider. Gentile, Bishop’s Laserfiche Document Management Specialist, invited Records Management staff from the agency to attend a workshop to see Laserfiche in action. Nelsen and her staff saw how Laserfiche Quick Fields could create files on the fly. Once files were created, Workflow could then notify decision makers of pending approvals and track those approvals throughout multiple business processes.

Nelsen was impressed. “We fell in love with Workflow,” she says, citing how it could help the agency:

• Transmit insurance information to the billing office.
• Send lab results to physicians.
• Route medication orders to the pharmacy.

“We’re a multidisciplinary team caring for people across a continuum, so that ability to share documents between departments, reduce paperwork and improve communication would greatly increase efficiency and positively impact patient care,” she adds.

Thus inspired, Nelsen and her team purchased a 30-user Laserfiche Rio pilot system and have spent the first half of this year preparing to roll it out. “Laserfiche Rio made the most sense in terms of meeting our immediate needs. It includes Workflow and the Records Management component to work with our EMR, as well as unlimited servers.

“As we progress, we can just add users to grow the system to meet our future needs and goals. Scalability was a big factor in choosing Laserfiche Rio,” Nelsen explains.

Goodbye filing cabinets, hello automated patient charting

Eastmont Towers’ medical records staff is now halfway through a backlog conversion process that Nelsen anticipates will eliminate at least four filing cabinets by the end of the year. Meanwhile, Nelsen and her staff have been analyzing business processes to guide the upcoming implementation. “After we had our initial training, we sat down to map out what exactly we do with our documents, where they are sent and why,” she says.

Initial focus has been on automating the patient charting process to compile and distribute client records and information as they enter Eastmont Towers from hospitals and other healthcare agencies. “We have several departments we need to route various information to, so we needed a way to streamline and simplify everything coming in and have it work with our EMR so staff could find everything in one place,” explains Nelsen.

Eastmont Towers is currently working with Gentile and Laserfiche consultants Our Support Services to automate and streamline the patient charting process:

• When a patient transfers to Eastmont’s Skilled Nursing facility, Quick Fields generates a chart by recognizing document types from an Excel spreadsheet.
• Quick Fields then populates metadata template fields according to patient name and ID number.
• Quick Fields then builds the folder structure out according to what documents fall under respective chart headings.
• Workflow then notifies the pharmacy and dietician according to document type (nutrition information, etc.).

Prior to implementing Laserfiche, paper files all had chart tab dividers. Every time a document was added to that tab, all documents had to be removed from the file so new information could be filed in the appropriate spot, then documents would be replaced in the folder and the folder refiled. A new feature in Laserfiche 8.2, dynamic fields, greatly simplifies this process, Gentile explains.

“When a ‘tab’ item is selected from the ‘Chart Tab’ field drop down, the ‘Chart Doc Type’ drop down list automatically populates to correspond with the documents that fall under that ‘Chart Tab’ category,” she says. “It’s saved staff a lot of time.”

Immediate practicalities, limitless possibilities

As Nelsen and her team continue to come up with ideas for future process automation, she sees even more potential for Laserfiche. “We wanted something that was would be fairly easy for the end user to learn but that also could streamline our processes better, and Laserfiche has met and exceeded our expectations,” she says.

Next up, she says, are integrations with the agency’s Keane clinical and financial software to support current EMR deployment and refine and automate processes in the Accounting Department. “We see a lot of value in having an ECM system that’s flexible and adaptable enough to meet clinical and non-clinical needs throughout our agency,” Nelsen adds.

“We have a lot of time and resources invested in our existing technology, so it’s important that Laserfiche enables us to build on the progress we’ve already made without interrupting the ways we’re used to working. Plus, the way Rio’s set up, we can keep building with it, which is very appealing to us. Technology’s always changing and Laserfiche is a great tool to adapt along with it.”

Screenshot of Eastmont Towers' table used to populate the template's dynamic fields by chart type.

The drop-down menu where users select Chart Doc Type to automatically populate the list with specific documents, instead of having to manually sort through tab dividers to find the paper file.

Challenge: Document management efficiency

Located across three campuses, Indigo North Health operates on a tight budget, balancing the provision of quality services with a streamlined yet highly efficient staff and infrastructure. Not surprisingly, internal efficiencies that contribute to improved services are a high priority for the organisation’s CEO, Cameron Butler; and high on the agenda in late 2009 was document and file management.

“We rely heavily on suppliers and contractors,” Cameron says. “So it’s important for everyone that the flow of information, whether in the form of general correspondence or finance-based documents is incredibly efficient. Unfortunately, this wasn’t the case; and with the business having doubled over the past five years, we were in the position of having to identify and implement a more efficient means of managing our documents and files.”

Answer: A Laserfiche solution

In partnership with Copy Print Scan (CPS) Albury, a Ricoh Business Partner, Indigo North Health sought to evaluate the suitability of a Laserfiche and Ricoh MFD (Multi-Function Device) solution. Following an extensive evaluation process, Cameron gained approval from the organisation’s board to partner with CPS on the solution’s implementation.

“The first and most important aspect of our document management on which we worked with the CPS team was our accounts payable invoice approval process,” Cameron says. “And by the first of July 2010, we had a streamlined workflow that’s nothing short of fantastic.”

Saving a day every fortnight

Streamlining the accounts payable workflow for invoice distribution and approval has delivered an immediate saving of eight to ten hours every fortnight. On that alone, it’s a saving that represents a near full return on investment in barely 12 months.

So where does that saving come from? Firstly, as invoices are received—either electronically or in hard copy—from suppliers and contractors, they are immediately transferred to the organisation’s Laserfiche system where they are assigned to a particular cost centre. At this point, the customised workflow developed by the CPS team kicks in and an email is automatically sent through to the cost centre’s manager.

The savings realised up to then are through:

• Eliminating the manual distribution of invoices.
• Reducing the instances of having to request misplaced invoices from suppliers.
• Removing the need to manage a large number of paper-based accounts payable files.

Next, it’s the Laserfiche-based approval process that adds even greater efficiency and savings. With the e-mail received, cost centre managers receive an embedded link to the invoice, which, when clicked, displays the invoice on their screen along with the ability to approve or deny the payment, specify an expense code and add notes for the accounts payable team if required.

Once closed, the approved or denied invoice is sent immediately through to the accounts payable team who then take the appropriate follow-up action. Again, the savings accumulate. This time, though, through:

• Streamlining the invoice approval process.
• Achieving instant transmission of approvals from the cost centre manager to accounts payable.
• Fully eliminating instances of invoices lost in transit.
• Dramatically reducing the “chasing up of approvals” by accounts payable.

“Laserfiche has delivered even more in cost and time savings than we initially expected when it comes to the accounts payable workflow,” Cameron states. “For cost centre managers, invoice management has become a simple and straightforward process, and for the accounts payable department, there are new high levels of accuracy, accountability and time efficiency.”

A well-defined audit trail

What then of purchase orders that relate to the invoices? “Quite simply, we have a Laserfiche folder containing invoices and another for purchase orders,” Cameron explains. “When the invoice is filed, it’s matched with any corresponding purchase orders so when the invoice is sent through, the cost centre managers are immediately able to verify its details against those stipulated in the purchase order.”

A key enabling factor in the matching of invoices to purchase orders is the advanced and highly accurate OCR (Optical Character Recognition) capabilities of the Laserfiche solution. Whether invoices are scanned in at the MFD or received by fax, the solution automatically scans and translates each word on the document, then updates an integrated index database.

“When we need to locate any document, whether it’s an invoice, purchase order or anything else that we’ve filed in the Laserfiche system, it’s a simple case of entering a supplier’s name or any other search criteria into the search field, and it’s there immediately,” Cameron says.

“The time this is saving everyone is definitely one of the key reasons this solution is being so well accepted and utilised by our organisation.”

An extended application

Having recognised the document and file management benefits of the Laserfiche solution, Cameron was quick to take the lead within Indigo North Health and initiate Laserfiche filing of business correspondence, patient records, and Board documents and meeting minutes.

“We’re a relatively small organisation, and even as the CEO I don’t have the luxury of a personal assistant,” Cameron states. “For my correspondence, one of the admin team uses the Ricoh MFD to scan in everything and drop it into my correspondence folder. From there, I’m able to browse through it all, search for any related documents and file it into my own Laserfiche file folders.

“For the admin team, all that’s required is to stack the correspondence into the MFD’s document feeder, press a couple of buttons and that’s it,” Cameron continues. “In a matter of a minute or so, all my daily correspondence is scanned, filed and available online.”

Understanding the business

It’s well worth noting that while the Ricoh MFD and Laserfiche are the two core elements that have supported achieving those early savings, the equation is significantly more than being simply the sum of the two. It is the tight integration existing between the two technologies, along with the high levels of customisation and integration that enabled the CPS team to create workflows that have proven to be precise matches for Indigo North Health’s business needs.

“When the project commenced, we had in our minds what we wanted to achieve,” Cameron explains. “But then, there are workflow requirements that are specific to our business and to the industry in which we operate. Bringing our ideas and goals to reality was only achieved through committed work from the CPS team to understand our business, talk to our administration staff members, thoroughly document the manual processes and then apply that knowledge to the solution.

“It’s that same commitment and expertise that we fully expect will underpin the growing range of applications we have in mind for the solution. For us, the Ricoh MFDs, Laserfiche, support and expertise are fundamental to our ability to improve efficiencies and deliver even better services to our community.”

Mergers and acquisitions account for much of SEPT’s growth, but innovation, says Dominic Malvern, Head of Information Systems Development, accounts for much of its ongoing success. “It’s never been a stereotypical government ‘Mental Health Organization,” Malvern says.

In fact, when SEPT transitioned from a purely state-funded trust to a more privatized “Foundation Trust,” one of its primary initiatives was to partner with Adobe to develop an EMR system using its LiveCycle products supported by a Laserfiche ECM system from Laserfiche reseller ScanDoc/Fortus. Malvern saw the chance to hit the ground running with a pilot project in the trust’s Forensic Services Department, which was moving to a new building as part of a modernization program.

“It was the ideal opportunity for us to modernize how our live patient records were accessed, as it was apparent that continuing with a manual process was not in keeping with the state of the art service we provide to our patients,” he says. That process, he adds, had remained manual by default because the legacy imaging system in Forensics didn’t meet the Trust requirement for working with live patient records.

“A single patient record could run for several years, sometimes through a person’s entire adult life, so it would extend into several volumes,” he explains. “Constant patient monitoring meant frequent updates to records for many reasons such as observation or treatment plans, sometimes every 15 minutes.”

A Pilot That Needed To Fly 24-7

When choosing a department to establish proof-of-concept before deploying a full-scale EMR system, SEPT couldn’t have chosen a more challenging one than Forensics Services—or one in which the impact of a successful ECM implementation would be so pronounced.

Malvern worked with ScanDoc’s Steve Livermore to implement a Laserfiche pilot system for active patient records management system using:

• Quick Fields advanced capture to input, sort and file the steady stream of patient information.
• Workflow to automatically route information for reviews, approval and distribution.
• Web Access to allow both remote deployment and access to the system over SEPT’s broad geographic service area and affiliated agencies.

SEPT implemented a clinical pilot project in 2009 and, over the course of a year, the new system kept up with the staff’s round-the-clock demands, amassing over 500,000 documents in the Laserfiche repository in the process.

Malvern says the real breakthrough operationally was having a system aligned with the increasing need for information sharing between regional service offices. “Increasingly we have to work on a multi-disciplinary and multi-agency basis, so having shared but secure access to patient records and notes is vital,” he says.

From an IT perspective, Web Access gave the organization one more tool to centrally control system administration while capitalizing on Laserfiche’s flexibility to configure various access levels remotely.

“Being able to deploy the system through our server or using Web browser options allowed us to control the type of access we wanted to make available,” says Malvern. “Web-based deployment is key because of the ease of maintenance when working with such a large group of users. Updates and upgrades would be unwieldy to deploy with a large number of single desktop clients.”

Going from EMR to ECM Saves $1.5M

The vision to extend Laserfiche from its supporting role in SEPT’s EMR project to a full-scale ECM deployment came with the support of ScanDoc/Fortus’ Livermore, who helped Malvern make the case to SEPT’s directors to implement Laserfiche for the trust’s non-clinical side.

“Once I heard the directors were looking at other solutions, and knowing what Laserfiche was capable of, it seemed a waste to restrict its application to purely clinical processes,” says Malvern. “Of course, it seemed an even bigger waste to spend further public money on more software that would be superfluous when we had a perfectly good system that would likely be better than anything else on the market.”

Now moving ahead with full-scale deployment of its Rio system to what will eventually be 3,000+ users, SEPT is effectively standardizing its information management on Laserfiche, eliminating the need for multiple departmental systems—and their corresponding service agreements and upgrades.

“Initially Laserfiche was envisaged solely as a clinical and medical records solution, but we have now realized that it can be a complete multi-functional document management system for the whole organization,” he says.

“We’ve begun implementation in non-clinical areas such Human Resources and Finance, as well as Vehicle Service Management, where we’re using Quick Fields and Workflow to automate our lease applications.” Additionally, another major project is underway to use Laserfiche to meet Information Governance Corporate Records retention regulations.

“From a roll-out prospective, it makes life much easier to have one multi-tasking system that all employees are trained on no matter what their function. It makes live support a far more streamlined and efficient activity,” he explains.

Malvern says the efficiency—and cost-savings—are starting to add up. “Within 18 months to two years we’ll be able to replace all our legacy imaging systems with Laserfiche. Implementing Laserfiche and its enterprise licensing enables SEPT to discontinue several annual contracts and service agreements. It also delivers savings on labor and print costs for information requests, as well as paper document archive and retrieval services. Realistically, this will save us US$1.5 million over the next three fiscal years,” he says.

With so many specialties—and specialists—IMC’s Board of Directors wanted to use electronic medical records (EMR) software to improve operational processes, encouraged by the promise of ARRA stimulus money to help fund it. But IMC’s Practice Administrator, Christine L. Holliman, CMPE, took a more pragmatic view of the situation.

“All vendors talk about the efficiencies of an EMR and the increase in the levels of coding that can be achieved from full implementation,” she says. “As my physicians are many different ages, the idea of transitioning to a full-blown EMR was daunting, to say the least.”

And expensive, especially in light of what Holliman perceived as a fundamental lack of functionality. “The document management portions of the leading EMR systems we looked at, including Greenway, Centricity and Allscripts, didn’t utilize OCR [optical character recognition] technology or any other shortcuts for actually scanning and filing documents,” Hillman notes. “Most EMR systems require manually sorting and dragging and dropping individual documents either back to an order or back to a patient record—very cost prohibitive in my opinion.”

Holliman focused on finding an enterprise content management system to establish electronic patient charts (e-charts) first. “Looking for a way to handle the paper felt like the most logical step in streamlining our practice in preparation for an EMR,” she says.

“As most of our physicians are still primary care, the sheer amount of paperwork we receive is just incredible,” Holliman adds. “We’d receive 2 ½ feet of paper a day in faxes, print-outs and mail—and that’s just from one of the two hospitals we work with.” At the same time, she notes, “as a multi-specialty practice with 20 providers, having a system that could allow access to patient records by multiple departments and personnel was critical.”

The 2 ½ Feet of Paper Stops Here

Holliman was introduced to Laserfiche by Jim Bergeron of reseller JPI Data Resource at the 2009 MGMA conference in Denver. She then met Bergeron again at a local HIMSS meeting. Encouraged by Laseriche’s ease of use and its flexible business process management (BPM) automation tools, IMC purchased a 44-user Laserfiche Avante system with Workflow business process management and Quick Fields capture tools to establish electronic patient charts.

“As anyone who has implemented new systems knows, the end users are the biggest variable. If they’re on board, the implementation will be a success,” Holliman says. “With 140 employees with varying computer experience, it was very nice to implement a product that anyone could be taught to use in just a few minutes.”

Key to establishing IMC’s e-charting was automating the way the clinic received patient information from the two hospitals it works with. Using Laserfiche in conjunction with the MD Network, an electronic patient information distribution platform, incoming documentation from hospital visits is processed by Quick Fields’ high-volume capture and processing tools, then automatically filed in Laserfiche according to patient name and date of birth, where it becomes part of patients’ e-charts.

A significant amount of this data is test results, which need to be reviewed by physicians; this review often prompts follow-up instructions and further review. “One of the worries of both physicians and practice managers is if test results have been reviewed and relayed back to the physicians,” says Holliman.

Prior to using Laserfiche, staff had to sort through faxes or independently request each report from the hospital while nurses manually pulled the paper charts. “We always worried that something got filed in a patient’s chart before it was ever reviewed by the physician,” Holliman adds. “We’d see 24 people a day and run tests on 22, and there’d always be that concern that there’s one ultrasound report no one ever saw.”

Flexible Control: Reviewing Test Results as a Condition of Filing Them

To automate the test review process, IMC created separate “inbox” folders in the Laserfiche repository for each physician. Quick Fields recognizes “test results” as a document type and the physician’s name associated with it, which Workflow then uses to route the results to the appropriate doctor and nurse’s folder. Workflow then alerts them they have items in Laserfiche for review. If a review deadline is not met, Holliman herself is notified.

“One of the things we really liked about Laserfiche was that all of our doctors can set their own parameters as far as what they need to see in their inboxes to review,” she says. A GI specialist who ordered a patient test, for instance, wouldn’t need to see an incoming discharge summary, but the patient’s primary care doctor would. The GI specialist would, however, need to review the results of a test he ordered, so only after he has reviewed it do the test and follow-up notes go to the primary care doctor’s inbox for review, and eventually to the patient’s file.

“Just using their inbox, each doctor can ask his or her nurse to follow up on their instructions. Whether it’s an abnormal lab or an abnormal chest X-ray, they can adjust medications or order further testing,” Holliman adds. The whole process is prompted, routed and tracked using Workflow.

The benefit, besides the economy of effort, is peace of mind, she says. “Our doctors can access the same, single inbox and know when they leave at the end of the day that they’ve seen every test result that needed to be dealt with on that day.”

Nurses who used to have to keep a manual log of all tests reviewed and what follow-up was ordered appreciate it as well, because logs can be generated automatically using simple search parameters. Plus, Holliman adds, “Being able to precisely track patient follow-up is a tremendous tool for mitigating medical legal liability costs, as we have an exact record of the doctor’s orders.”

IMC is also utilizing the Laserfiche/MD Network interface to automate other processes, such as recalling the dictation from an office visit. “After a report has been electronically signed, it’s printed in our medical records and stored automatically in Laserfiche. If, for some reason, a nurse on the floor needs that information before it’s been made a part of the patient’s record, she can still retrieve dictation from the last visit.” Likewise, when IMC’s triage nurses type up their notes from a phone conversation, they are automatically uploaded into Laserfiche.

Holliman credits Laserfiche’s ease-of-use as well as the overall efficiency of the system with the success of IMC’s e-charting adoption thus far. “The transition to a new system for people who’ve been utilizing a paper chart is very intimidating, but once they begin to use Laserfiche and see how truly easy it is to find and retrieve documents, they’re actually excited to get started,” adds Holliman.

A Natural Bridge to EMR—That Also Leads to Back Office Efficiency

Now that Laserfiche has made its impact on how doctors receive and act on incoming patient information, the clinic is rolling out Laserfiche for use in its business office, where Workflow will automate A/P processing and HR files updates.

“One thing that’s nice about Laserfiche is that it gives us a set of tools that can be applied to business management as well as practice management, so we’re really able to maximize our investment,” Holliman says.

At the same time, she adds, IMC is an important step closer to EMR adoption. “Laserfiche has definitely acted as an important bridge between where we were and where we want to be, and it’s done so in a way that’s been very natural.”

“Since 1954, our physicians have been refining the way they keep track of patient information,” says Bill Duke, executive director of the practice. “Although we knew we wanted to transition away from paper charts, we wanted our electronic records to mirror the form and format of our paper charts exactly. There aren’t many solutions out there that are flexible enough to do that.”

Duke would know. As the man in charge of the business side of the practice, he led the effort to find and implement a content management system. “Prior to 2007,” he says, “we used paper charts at all three of our locations. Storing so much paper took up a lot of space, and finding the right information took up a lot of staff time. And there was always the possibility that a document could go missing.”

For a practice dedicated to excellence, continued reliance on paper files was not the answer. “Providing state of the art care isn’t just about attracting the best doctors and staying abreast of the latest medical developments,” explains Duke. “It’s also about implementing innovative technology that helps your practice run as smoothly as possible.”

In 2007, Dallas Associated Dermatologists added a document management module to its billing software. The result, Duke says, was less than ideal. “What we got was basically a managed repository—the search functionality was limited, and you pretty much had to know exactly where you’d saved a document in order to locate it again.” It quickly became clear that the practice needed a more robust solution.

“The first time around, I confined my search to software that had been designed specifically for the healthcare community,” Duke explains. “The second time around, I looked further afield.”

Technology that Adapts to the Flow of the Practice

After describing the needs of his practice to a scanning company, Duke was directed to take a look at Laserfiche, a company that creates simple and elegant enterprise content management (ECM) solutions for organizations across a wide range of industries—including healthcare.

“I remember seeing a postcard from Laserfiche that said something to the effect of, ‘Our approach to electronic medical records doesn’t make doctors change the way they work.’ I thought, ‘If that’s true, then that’s exactly what we need,’” he says.

Duke began talking to ImageNet Office Systems, a Laserfiche reseller that’s also based in Dallas, and purchased Laserfiche in 2009. According to Brian Simpson, solutions manager at ImageNet, more and more medical practices are becoming interested in Laserfiche solutions because “they handle the business processes involved in automating the capture and processing of medical records in a way that’s not overwhelming, complicated or cumbersome for doctors and staff, and they do so in a way that addresses business needs outside the scope of an EMR as well.”

“A lot of vendors want to fit a round peg into a square hole by forcing you to use their templates,” Duke adds. “With Laserfiche, we can create our own templates, our own fields and our own classifications for documents. That flexibility gives us control over our output, and it lets our physicians continue to chart in the way that works best for them.”

According to Duke, the doctors at Dallas Associated Dermatologists want to interact with their patients during appointments and have balked at reviewing EMR systems that require them to type their notes into the system while they’re in the room with a patient. “That’s not conducive to building the patient relationship and providing high-quality care” says Duke. “Laserfiche provides us the opportunity to bring our documents to life without having a negative impact on our patient relationships.”

Technology that Accelerates the Flow of the Practice

Since implementing Laserfiche, the practice has been scanning patient records into the system on a day-forward basis. Laserfiche Quick Fields automates chart processing by capturing data from the practice’s various forms and sorting the documents according to custom criteria. Once the information has been indexed and stored in the Laserfiche repository, it is immediately available to Dallas Associated Dermatologists’:

• Doctors and Nurses
• Front Desk
• Appointment/Service Center
• Telephone Triage (Rx refills, Special Request)
• Billing and Collections

“With Laserfiche,” Duke says, “there’s no such thing as a failed scan. Our users can quickly and easily verify the scan or find anything that’s been scanned into the system, using whatever search method they prefer. Nothing is lost, and that helps me sleep better at night.”

In addition to the ease of search and retrieval, the practice also benefits from the business process management (BPM) tools included in the Laserfiche suite. “Workflow automates much of our sign-out process for physician notes,” Duke explains. “Once transcriptions have been imported into Laserfiche, they’re automatically routed to the Transcriptionist folder where they’re linked to their .wav files. We’re also testing how to automate other paper-intensive processes, such as prescription refill approval, using Workflow.”

The practice is also working to implement Laserfiche in areas of the business that are not directly related to patient charts, such as Accounts Payable, Inventory and HR. “EMR systems are focused exclusively on patient records, but Laserfiche is going to allow us to streamline operations across the practice,” says Duke. He anticipates that once the system has been configured to do everything he wants it to do across the practice, the time savings for staff will be huge.

In addition to the forthcoming efficiency gains, the practice is already benefitting from its ability to eliminate document storage. “Space that would have been used to store hardcopy files is now used for revenue-generating activities,” Duke explains.

“Laserfiche lets us do exactly what we want to do, in exactly the way we want to do it. Our staff takes pride in making sure our digital files are in tip-top shape, and we’re always looking for new ways to use Laserfiche to help make us more efficient,” he concludes.

• Cardiology
• Dermatology
• Gastroenterology
• General Medicine
• Neonatology
• Obstetrics and Gynecology
• Orthopedics
• Psychiatry

Prior to implementing Laserfiche in 2007, PPS’s manual cash posting process was paper-driven. But from an operational and cost perspective, paper wasn’t a particularly efficient medium for PPS; even assigning the daily distribution of work was time consuming because someone had to manually review that day’s lock box payments and portion them out to the processors.

“At first, we tried implementing a different system to improve the efficiency of our operation,” said Stacy Devine, IT director at PPS. “But we had some security concerns with that system, and it also had a higher cost.”

Soon after, Russ Surette, director of billing operations, mentioned the situation to Mike McDonough at Duplitron, a hardware vendor and Laserfiche VAR that had long provided PPS with printers, scanners, copiers and other electronic devices. “Mike suggested that we take a look at Laserfiche, because it’s so easy to use.”

After doing its due diligence by talking to a number of Laserfiche users, PPS purchased a Laserfiche enterprise content management (ECM) system to streamline operational processes and eliminate the need to store paper office documents and training materials.

Leveraging Laserfiche

According to Surette, the use of Laserfiche—in conjunction with a few other initiatives—has helped PPS increase productivity by 20% over the past year, while at the same time increasing gross billings approximately 20%. When one employee left the company, the increased efficiency meant that PPS did not need to fill that position.

Here are a few of the benefits Laserfiche provides:

• Better security of information. “When you’re using paper or a file server, it’s nearly impossible to keep track of changes or restrict people from removing content,” says Devine. “Laserfiche’s security controls allow us to restrict access to folders in the repository by department and user, so that, for example, a claims processor will only see his or her assigned claims. This helps us better protect patient information and more easily comply with HIPAA.”
• Automatic data capture. Laserfiche Quick Fields automates information processing by capturing data from various formats and sorting documents according to custom criteria. For PPS, Quick Fields has simplified payment processing by automatically extracting data such as check number, transaction number and insurance carrier from bank image files and tagging it as metadata in the Laserfiche repository, where the images are stored by date. Surette says, “Before implementing Quick Fields, we had a full-time employee who did nothing but scanning and data entry all day long. Today, we have one part-time employee who scans for about 10 hours a week.”
• Smoother payment processing. After payment information is stored in the repository, Laserfiche Workflow routes it to specific claims processors based on the bank account number/insurance company associated with the payment. After the payment has been processed, Workflow automatically sends the information back to its original folder. When a claims processor is out of the office, Workflow automatically delegates his or her work to an alternate processor. “The distribution of daily work is much easier with Laserfiche,” says Surette. “Nobody has to sort through files to figure out what should go where.”
• Faster follow up. “The optical character recognition (OCR) process available through Laserfiche has made searching so much easier,” says Surette. “In the past, processors would have to look through 200-page documents to find the one paragraph that was relevant to an insurance follow up. OCR makes searching for specific words and phrases within a document easy, and it’s dramatically cut down on the amount of time our processors spend following up on claims.”
• Increased visibility and oversight. Laserfiche Audit Trail monitors, records and reports on system activity, providing the management team at PPS with a comprehensive overview of how quickly payments are processed and the value of the payments processed on any given day. “Laserfiche reporting eliminates the need to check spreadsheets,” says Surette.
• Easy integration with GE Centricity. By serving as integrative middleware that links into GE Centricity, PPS’ practice management system, Laserfiche allows staff members to access information stored in Laserfiche through the click of a button. With the integration, processors can access information in the manner and environment with which they are most comfortable, without toggling back and forth between applications.

Results

“Over the past year, even though one of our employees left and hasn’t been replaced, we’ve increased business by about 20%,” says Surette. “Implementing Workflow has been a huge part of that.”

PPS is, in fact, so satisfied with Workflow that Devine, Surette and Duplitron’s McDonough are planning to do a demo of Workflow at a regional training session for GE Centricity users this fall. “We recommend Laserfiche to other billing companies all the time,” says Surette. “When you’ve got something this good, you can’t just keep it to yourself.”

The hospital relies heavily on paper—particularly for patient records. Some nursing documentation is housed in Meditech, but none of the physician orders, progress notes or surgical packets are handled electronically. With over 500 physicians and an additional 100 residents serving THE MED’s patients, the HIM department is forced to manage an overwhelming amount of paper records.

Building the Case for Enterprise Content Management

Prior to implementing Laserfiche, the HIM department had to store many of the hospital’s paper records onsite because researchers routinely required access to files. This, of course, uses valuable real estate that can be put to better use caring for patients.

But it wasn’t just the clinical staff that needed access to patient records: HIM frequently found itself copying and/or carting charts to various departments, leading to processing inefficiencies and delays.

The HIM department tried to solve its paper problem by using a vendor to scan records to the vendor’s database. However, outsourcing this important task didn’t yield positive results, as the vendor did not always properly index the records, making it difficult for hospital employees to find the desired electronic files.

Rosson knew the HIM department needed to find a better way to manage its records, but cost concerns were a limiting factor, particularly when it came to traditional electronic medical record (EMR) systems.

“THE MED is the ‘safety net’ hospital for the area,” she explains, “so we serve a large number of people who are unable to get care elsewhere.”

It was obvious that an EMR solution from the likes of Cerner or McKesson—which can cost millions of dollars—was out. Rather than scrapping the idea of EMR altogether, though, Rosson decided to take an incremental approach.

Laserfiche Becomes the Cornerstone for Hybrid EMR

Rosson’s vision centered around the creation of comprehensive EMRs that include current and historical nursing documentation from Meditech, physician documentation, pathology reports, EKGs and more. “I didn’t want employees to have to piece together a complete patient record from a variety of sources,” she says. “I wanted everything to be central and secure.”

The hospital’s CFO encouraged her to investigate an EMR solution from another vendor. “The vendor stated that its current solution didn’t have the functionality I needed just yet, but if I could wait a year, the next release would blow me away,” Rosson says. “I’m not going to waste a year waiting for something that may or may not happen.”

Instead, Doc Imaging, the company that manages THE MED’s copiers, proposed Laserfiche Rio. “From the very first demo, I thought Laserfiche was the answer,” Rosson says.

In terms of features and functionality, the HIM department was particularly impressed by Laserfiche’s:

• Ease of use.
• Robust and flexible storage.
• Advanced search.
• Granular security.
• Affordable price.

As a result, the hospital decided to purchase Laserfiche in December 2009, implementing the system in February 2010.

Breaking Ground with Hybrid EMR

Although Laserfiche has only been in place a little over six months, THE MED already uses Laserfiche to retrieve ER, inpatient, day surgery and ancillary records. “Any medical record documentation that’s not in Meditech gets scanned into Laserfiche,” Rosson says.

She adds that the hospital uses Laserfiche Quick Fields, a high-volume capture tool that automatically sorts, organizes and stores documents, to batch scan records into the system.

Pathology reports (and soon EKGs) are “cold fed” directly into Laserfiche, eliminating the need to print and store hard copies.

Each patient’s record is organized in the repository by visit number and medical record. “Our goal is to ‘ghost print’ everything from Meditech—including nursing documentation—into Laserfiche so the complete record is available to our physicians through the Laserfiche system,” the HIM director explains.

According to Rosson, physicians access records through the Web, using Laserfiche’s advanced search capabilities to quickly locate the records they need. “Laserfiche is so intuitive that users can pick it up with virtually no training,” she says.

In addition to the fast and easy access that Laserfiche affords, Rosson is excited because multiple users can view the same patient information simultaneously. “In my world, the fact that three people can be in separate rooms and all look at the same thing at the same time is huge! Laserfiche is a huge time saver in this regard.”

She also notes that THE MED’s file room is in the basement, which means HIM employees are constantly running up and down the stairs to retrieve paper files. “With Laserfiche,” she says, “our physicians don’t have to wait for someone to finish reviewing a chart, or for my department to make them a copy. They just log into Laserfiche and everything is right at their fingertips!”

Moving forward, Rosson is also excited that Laserfiche will enable coders to work from home. “The flexibility to telecommute is a big recruiting benefit,” she says, “and it frees up more space in the hospital for additional patient care areas.”

A Solid Foundation

Rosson is clear that what her department is doing with Laserfiche is more than mere archival: “We’re using Laserfiche to manage active medical records,” she says. “This is my EMR.”

Although the IT department would like to one day implement an EMR system with a CPOE component, Rosson stresses that for the time being, Laserfiche provides a sound and effective hybrid solution. “From a cost standpoint, from an access standpoint and from a productivity standpoint, Laserfiche is giving us everything we need right now.”

Besides, she points out, even if THE MED migrates to a complete EMR solution, “there’ll still be paper to manage. It’s not like the need for a content management solution is going to go away.”

• Providing in-home services to help homebound older people live in their own homes as long as possible.
• Helping active older people stay fit, healthy and involved through senior center programs and volunteer opportunities.
• Providing family caregivers the resources and support they need to maintain their own lives while caring for older loved ones.

But with 19,000 clients, CareLink was contending with a challenge of its own: filing, storing and accessing customer charts and other documentation in a timely and efficient manner.

Paper’s Pain Points

According to Luke Mattingly, CareLink’s chief operation officer, the agency employs 740 employees, with many of them providing home-based customer care. Some of these field employees live and work nearly 100 miles away from CareLink’s main office, which made filing and accessing customer charts a time-consuming and difficult task—one that took away from the face-to-face time they could spend with customers.

“Our employees are kind and compassionate people who entered this field in order to help senior citizens,” says Mattingly, “not spend hours filing and retrieving reports.”

In addition to staff productivity concerns, CareLink’s paper-based processes also caused delays when it came to funding. As a nonprofit, the agency receives funding from a variety of sources, including:

• Medicaid.
• Federal awards.
• State assistance.
• Private insurance companies.
• Personal donations.
• Private individuals (fee for service).

“We have thousands of customer charts and documents related to a variety of funding sources, and we get audited by third parties in conjunction with their funding requirements,” explains Mattingly. “Paper is just not conducive to quick and easy audits, particularly in the document collection phase.”

Electing to Go Electronic

In 2006, CareLink decided that enough was enough: the agency needed to find a solution that would allow it to do away with paper records and manage electronic content instead.

After evaluating several systems, CareLink found that “Laserfiche had the features and operational capabilities we were looking for, including excellent security, comprehensive records management and ease of use.” Plus, adds Mattingly, “Laserfiche was offered by Datamax Micro, one of our long-time, trusted vendors, and we knew that we could count on them to implement the system according to our needs.”

How ECM Helps

Implementing an enterprise content management (ECM) solution has transformed the way CareLink handles customer information in a number of ways:

• Electronic customer charts increase employee efficiency. With Laserfiche, field employees no longer have to travel to the main office to retrieve and file customer charts, which greatly enhances their efficiency. They simply access Laserfiche via a Citrix connection and find and file electronic records in the Laserfiche repository. According to Mattingly, this ability to capture documents in the field saves significant staff time. With distributed capture, CareLink has created a five-day filing rule that ensures data is uploaded to Laserfiche on a regular basis. This keeps charts current and protects against the possibility of losing files due to local hard drive failures.
• Automated filing process increases organizational efficiency. Using Laserfiche Quick Fields and Workflow, CareLink has created a quick and easy way to capture, index and auto-file documents in its Laserfiche repository. “Quick Fields captures our customer charts, saves them to the correct location and extracts index field data from specific areas of our forms in order to pre-fill our templates. Workflow further enhances the process by automatically populating template data based on folder name/designation. The automated filing process has been marvelous at eliminating manual data entry and saving staff time,” Mattingly reveals.
• Enhanced security eases HIPAA concerns. Prior to implementing Laserfiche, customer charts were kept in a large file room where it was impossible to be 100% sure that personnel only had access to the records of their assigned customers. In addition, staff sometimes forgot to record when a file was removed for review. “The granular security controls in Laserfiche eliminate the possibility that employees can view customer files they’re not supposed to see,” says the COO. “The system also provides an audit trail so that administrators can easily see all the activity that’s taken place on any given file.”
• Easier access to information eases audits. “In conjunction with our funding requirements, CareLink is audited by third parties on a regular basis,” Mattingly explains. “Laserfiche sped up the process of retrieving documents when those entities show up unannounced.” The system has also simplified internal audits that are designed to ensure that various departments and individual employees are completing an appropriate amount of work. “With Laserfiche’s advanced search capabilities, we can quickly determine the number of documents filed by any employee or department during a given date range. This has been very helpful and saves us a lot of time,” Mattingly says.

But customer charting isn’t the only area of agency operations that has been enhanced by ECM. Finance uses Laserfiche to manage financial documents, check registers and payables invoices. The fundraising department uses it to keep track of content such as proposals and thank you letters. HR uses it to control personnel files, time sheets and employee training files. In addition, the repository also houses organizational policies and procedures, letters, correspondence and individual employee files.

“Laserfiche started out as a solution for electronic charting but it’s grown to encompass so much more,” Mattingly says.

Return on Investment

According to Mattingly, Laserfiche has enabled CareLink to cut its paper consumption in half. Over the past three years, paper savings and the reduction of off-site storage costs have completely covered the cost of purchasing the system. “Over the next seven years,” Mattingly states, “eliminating off-site storage entirely will offset the annual maintenance fees for Laserfiche.”

Mattingly reminds us, however, not to forget about the cost savings associated with the efficiency gains CareLink has gained through its use of Laserfiche: “We estimate a 40% efficiency gain for audits, for example, and our field staff has absolutely seen a productivity boost. Although we haven’t assigned these gains a dollar value, this is where the real savings lie.”

“I’ve been in HIM since 1986,” explains Patty Hall, privacy officer and director of HIM at Wythe County Community Hospital, a 100-bed facility located in the Blue Ridge Mountains of southwest Virginia, “and I have to tell you that having an electronic solution makes things so much easier.”

A transplant from a hospital in Illinois, where she had worked with electronic health records for years, Hall was determined to decrease Wythe’s dependence on paper and improve the ease with which clinical, clerical and billing staff could access the patient information they need.

“I had a very specific idea of what I wanted in a content management solution,” she says, “and I worked very closely with the team at EMI Imaging [a Laserfiche reseller] to make sure that they could accommodate my requirements.”

Convincing Corporate

Hall was quickly sold on Laserfiche due to its rich functionality and affordable cost, but convincing Wythe’s parent company of the system’s merits was a tougher nut to crack. “LifePoint Hospitals uses a different content management solution, and they were fairly adamant at first that we should go with the system they had in place,” she says.

According to Hall, EMI made the difference by designing a very detailed, highly customized demo for the representatives from LifePoint. “After the demo, the lady from corporate headquarters told me that she’d come out to Virginia with the intention of nixing the Laserfiche proposal, but after the demo, she just didn’t see a way to say no; it was such a perfect fit for our needs.”

Wythe purchased its Laserfiche system in August 2009. In less than a year, the hospital’s repository has grown to manage more than 2,152,886 pages of records. “Working with EMI, we were able to deploy Laserfiche very quickly,” explains Hall. “Today, nearly 100 of our 415 employees use Laserfiche to some extent.”

Leaving the Paper World Behind

In 2009, Wythe had a total of 7,200 inpatients and 37,300 outpatients, performing 3,300 same-day surgeries and treating 15,000 people in the ER. With so many patients coming through the doors, digitizing medical records has been a huge time saver. “Many of our ER patients, in particular, come back more than once,” says Hall. “When you’re living in a paper world, it takes time to track down their records. Laserfiche makes it instantaneous.”

Although some technology solutions require intensive staff training, the HIM director notes that Laserfiche is pretty much the exact opposite. “Laserfiche is very user friendly. If you know how to use Microsoft Windows, you can use this system. For some of the less tech-savvy staff, we conducted 15-minute training sessions. That’s really all anybody needed to get up and running.”

Laserfiche delivers a number of benefits on the clinical side, including:

• Electronic EKGs. Physicians log directly into Laserfiche, where they can view labs, radiology reports, EKGs and ER reports for outpatients and ER visitors. (Inpatient charts are not yet being managed by Laserfiche.) “Having the EKGs in Laserfiche is a big benefit for our doctors,” Hall explains. “While our Meditech system makes labs and radiology reports available electronically, the EKGs don’t have a place in any other software application. To have them accessible through Laserfiche, in a crisp image, is fantastic.”
• Centralized Charts. Hall also acknowledges that having a centralized digital chart available through one interface (Laserfiche) makes it easier and faster to access all of the information relevant to any given patient. Labs, EKGs and radiology reports are batch scanned and captured electronically using Laserfiche Quick Fields, a high-volume capture tool that automatically sorts, stores and creates folder paths for these documents in Wythe’s Laserfiche repository. Charts are tabbed and separated into sections that make it fast and easy for doctors to locate the type of information they need.
• Quick Digital Searches. Kim Newman, the HIM department’s lead operations technician, notes that the optical character recognition (OCR) process available through Laserfiche translates printed words into alphanumeric characters that the system indexes for full-text search, giving Wythe the opportunity to search for specific documents using a keyword or phrase. This capability has come in particularly handy when radiology reports were misfiled. “Searching by the patient’s medical record number enabled me to quickly find the missing report and save it to the correct chart. If this had happened before we implemented Laserfiche, we may have had to spend hours and hours searching through every chart processed on a particular day of service, and even then we may never have found the misfiled report. Laserfiche OCR is a real timesaving tool!”
• Easy-to-Access Advance Directives. In addition to the patient charts, the hospital’s HIM department has created a folder for Advance Directives, organized by patient name. Having these important documents in Laserfiche is particularly useful in the case of emergencies. In the past, paper copies may not have been discovered quickly enough to make an emergency patient’s wishes known to medical staff. With Laserfiche, a simple search rapidly reveals whether or not a patient has an Advance Directive on file; if such a document exists, the patient’s preferences are immediately identified and honored.

Back-Office Benefits

But it’s not just the clinical staff that benefits from Laserfiche; the patient access (registration) department, the business (finance) office and the lab director (who is in charge of compliance), all use Laserfiche, too.

“Before Laserfiche, Patient Access made four copies of each patient’s records; now they make none,” says Hall. She also notes that the hospital now sends its ER billing information to its outside billing company electronically, adding to the cost savings Wythe realizes on printing, storing and mailing paper documents.

Facilitating Compliance

As the hospital’s privacy officer, Hall is responsible for investigating HIPAA complaints. Laserfiche Audit Trail, which tracks repository activity and provides a Web-based interface for running detailed reports on the tracked information, allows her to monitor all system activity—who looked at various records, what time records were viewed, whether any changes were made, etc.

However, Hall notes that the security controls in Laserfiche make it virtually impossible for unauthorized people to view information they are not allowed to access. “We limit access to the content in our repository based on folders,” she says. “For example, the patient access department doesn’t see the same things our physicians do.”

Corporate audits conducted by LifePoint are also much simpler now that Laserfiche is in place. With Laserfiche, the hospital is able to grant auditors secure access to a folder containing all of the documentation that needs to be reviewed. “Laserfiche allows us to prepare for audits on very short notice,” explains Hall. “It’s a lot easier than finding and copying paper documents and putting them in the mail.”

What’s Next

Wythe is currently in the process of implementing Laserfiche in the physical therapy department, and it hopes to tackle inpatient records before too long. Hall is also interested in adding electronic signature functionality to Laserfiche. Although her department doesn’t currently have the budget for it, she’s hoping to get money approved for it next year.

Overall, though, Hall sees Laserfiche as “a much larger solution for the hospital. This isn’t just something that the HIM department can benefit from; it would be a great thing for departments like HR and credentialing, and for the hospital as a whole.”

But medical records are only one area in which providers can reap the benefits of working with secure, digital files. For organizations such as Molina Healthcare, a managed care organization (MCO) serving low-income individuals who frequently depend on government assistance, implementing a Laserfiche enterprise content management (ECM) system to digitize and streamline the healthcare provider credentialing process has proven to be extremely valuable.

The Importance of Credentialing

Credentialing is integral to the success of any healthcare organization, but it is a particularly important process for an MCO like Molina Healthcare. Effective credentialing helps MCOs manage liability risk, attract customers and obtain accreditation from organizations such as The Joint Commission and NCQA. It is also a procedural requirement by federal agencies such as CMS and various state agencies.

Molina Healthcare, a Fortune 1000 company that operates in nine states—California, Florida, Ohio, Michigan, Missouri, New Mexico, Texas, Utah and Washington—handles more than fifteen thousand provider applications a year. Legally, a healthcare practitioner cannot participate in Molina’s network until the credentialing process is completed and a determination has been made to approve that provider for participation.

“Every day a provider remains in the credentialing process,” says Ryan Boe, corporate credentialing manager at Molina Healthcare, “is another day that he or she can’t provide care for our members.”

According to Boe, applications frequently consist of 30-100 pages of material, including a physician’s state license, board certification, criminal history report, stated work history, educational background, malpractice history and more. “Dealing with paper,” he says, “is much slower than working with electronic records.”

Paper Process

In the past, Molina’s credentialing department produced a single paper copy of each application and routed it to different people during the credentialing process. According to Michael Eisenman, healthcare analyst for the credentialing department, coordinating the logistics and timing for moving applications through various steps of the process was difficult.

“When you’re reviewing hundreds of applications a month, it’s not practical to physically transfer them one-by-one,” he says. “But transporting hardcopy files in batches leads to processing bottlenecks, which slows everything down.”

From a cost standpoint, printing paper applications consumed reams and reams of paper, and the special couriers who shipped credentialing files between offices were an additional expense. Additionally, the physical space needed to store and retain the documentation (including a great number of wall racks) led to extra cost.

Working with paper also brings up liability issues for MCOs like Molina: “HIPAA mandates that we keep medical information secure, but it’s hard to do that with paper files,” Eisenman explains. “Paper isn’t password-protected, and it doesn’t produce an audit trail.”

Implementing ECM

Tasked with finding the best way to digitize credentialing applications and automate key pieces of the credentialing process, an IT committee chose a Laserfiche Rio ECM system due to its rich scanning, workflow, security and auditing features.

Despite a few initial difficulties around business process engineering, solution design, training and adoption, the department soon ironed out the kinks, staggering the implementation state-by-state over a period of six months.

According to Sampath Nalam, technical lead in Molina’s IT department, the system’s ease of use accelerated its adoption. Initial product training and consistent technical support from the Laserfiche technical team also helped Molina to understand the Laserfiche product architecture, resolve implementation issues and accelerate the project deliveries.

The IT department trained the credentialing managers, who then trained their staff. “Most users picked it up pretty easily within a couple of days,” says Nalam. “It’s not too complex for users to understand and navigate through the Laserfiche application.”

Eisenman echoes this sentiment: “Laserfiche is very intuitive for users. It’s pretty close to point and click.”

ECM in Action

In order to put Laserfiche into action, one of the first steps for Molina was to restructure its credentialing process to take advantage of the system’s capabilities. “Today,” says Eisenman, “all roads for credentialing lead to Laserfiche.”

When a practitioner is being credentialed with Molina for the first time, departments outside of Credentialing obtain the application data—either from a physical application or from CAQH, one of the largest credentialing data sources in the country. The application data soon ends up in the credentialing department, which is where 85% of the work associated with the credentialing process takes place.

“We get a hodgepodge of data sets,” explains Eisenman. “XML data, text files, PDFs, spreadsheets, paper… the list goes on and on. We pre-process the data to make sure it meets our standards and organize it into an intelligent list, at which point it all goes into Laserfiche.”

In Laserfiche, the data is automatically filed—usually in large batches—in the Laserfiche folder structure. Once the information is in the system, the ‘Laserfiche workflow’ kicks in, alerting people to the various tasks they must perform on each application. For example, credentialing specialists populate template fields with metadata to indicate file completion or file discontinuance, which moves the file forward to a credentialing lead, who quality checks each file.

“We now have about 100 people using Laserfiche to some degree, and about 50 of those people use Laserfiche on a continuous and daily basis,” says Boe. “After a bit of trial and error, we’ve figure out our ideal process for implementing a centralized and paperless credentialing system.”

Measurable Results

Molina’s corporate credentialing department has realized a number of benefits resulting from its Laserfiche implementation, including:

• Decreased turnaround time (TAT) for processing applications by 44%.
• Twice as many applications processed per month.
• Greater visibility of information enterprise-wide.
• Faster provider network development.
• Decreased credentialing costs.
• Standardization of procedures and workflows.
• Improved security of protected information.

“The Laserfiche SDK has enabled us to automate an incredible amount of our data processing,” Eisenman says. “It has made the credentialing process much faster and much more consistent.”

“When we first started working with Laserfiche, there was a brief period when the TAT went up and our volume went down as we adjusted to the new process and the new technology,” Boe explains. “Once we’d conquered that initial learning curve and overcome the initial technical hurdles, however, the speed at which we can process applications skyrocketed. We’re currently completing approximately 1,500 applications a month, which is up from just under 800 a month a year back.”

Eisenman reports that Laserfiche has greatly increased the visibility of credentialing information across the company, while also decreasing the liabilities that are related to working with paper files. “Visibility has gone up, while unauthorized access to information has been eliminated,” he says, adding that the department’s paper costs “have fallen off sharply.”

“We’re very happy with Laserfiche,” Boe concludes. “It has accelerated the credentialing process and added a lot of value to our organization.”

“Most people don’t have pleasant memories associated with hospital stays: You’re sick, you’re scared, you’re away from your family,” says Shawana Rucker, IT manager at SSCBR. “SSCBR’s goal is to change all of that.”

Founded in 2003 as a physician-owned specialty hospital, SSCBR set forth to serve the needs of the local community. In 2008, the physicians partnered with Our Lady of the Lake Hospital and continue to provide a patient-focused facility serving the needs of the community. In this capacity, SSCBR is fully committed to providing the highest level of patient care. This commitment extends from architectural design to inpatient amenities, staffing and even medical records requests.

“As a specialty hospital, SSCBR uses the most advanced technology available to enhance the level of patient care—and not just in the operating room,” explains Rucker. “For example, Laserfiche gives us a user-friendly way to provide staff with instant access to the information they need to admit and treat patients. It also allows us to respond more quickly to patient requests regarding billing or medical records inquiries.”

Easy Road to EMR

With approximately 200 employees and a patient load of nearly 20,000 hospital services per year, SSCBR wanted to scan and store patient records in an electronic format, but its health information system (HIS) could not handle the high volume of content required.

“We’d only been open for a year,” says Rucker, “and we were already running out of space for record storage. We thought HIS would solve our problem, but when it didn’t, we turned to Laserfiche for help.”

In 2005, SSCBR purchased Laserfiche from JPI Data Resource, a Laserfiche reseller that specializes in healthcare deployments. “We chose Laserfiche because it’s so easy to use,” explains Rucker. “Although it doesn’t fulfill all of the government’s criteria to be considered a comprehensive EMR, Laserfiche has absolutely given us a centralized and secure way to manage our electronic records.”

To get records into the system, SSCBR uses Laserfiche Quick Fields, a high-volume document capture and processing tool. By automating the capture process as follows, Quick Fields eliminates the potential for keystroke errors when digitizing records:

• SSCBR puts barcodes on hardcopy medical records so that they can be easily scanned into Laserfiche.
• Quick Fields reads a barcode, automatically capturing important patient identifiers.
• Quick Fields automatically creates the folder structure and autofiles the patient’s scanned records.

“Laserfiche definitely makes life easier for our staff,” says Rucker. “It saves a lot of time on data entry with only minimal training. The only thing end users need to do in Quick Fields is tell the system where to store the records.”

In addition to simplifying patient records management, Laserfiche also streamlines admissions procedures by allowing SSCBR’s front-desk personnel to quickly scan and process insurance cards, driver’s licenses, patient history forms and more. Likewise, Laserfiche speeds the billing process by providing on-demand access to patient EOBs, claims and statements.

From a patient care perspective, Laserfiche enables staff members to locate medical records, admissions items and billing information within seconds so that they can answer patient inquiries faster. “Whether a patient is onsite or phoning in with a follow up question, our employees don’t have to search through boxes of paper files anymore,” says Rucker. “Laserfiche makes it fast and easy to keep our patients informed.”

Securing Compliance

As with any hospital or medical practice, protecting the integrity of patient information—and complying with HIPAA—is critical to SSCBR’s success. Laserfiche provides comprehensive security that protects sensitive information while still allowing authorized personnel to instantly access necessary files.

According to Rucker, SSCBR integrated Laserfiche with Windows Active Directory® to simplify the authentication process. “The IT department assigns Laserfiche rights and privileges to staff through Active Directory, which makes it easy for people to log into the system and easy for us to administer,” she says.

“We have role-based security in place. People in the admissions department see the admissions items. People in the business office see the EOBs. Clinical staff has access to the medical records. Most people have read-only access to the documents they’re authorized to view. With Laserfiche Audit Trail, we have the ability to run security audits, but I run them very rarely because the security controls are so good that people really can’t do anything wrong.”

What’s Next

SSCBR is very pleased with the benefits it has received from Laserfiche over the past five years. “The system is easy to use, it doesn’t require much training and it saves us a lot of time,” explains Rucker.

Moving forward, SSCBR is considering implementing Laserfiche Workflow in its purchasing department. Workflow enables organizations to automate collaborative business processes by designing custom workflows to fit their needs. A workflow automatically performs specified actions at appropriate times, such as sending a document to a specific user, populating a field, adding a tag or sending an e-mail.

According to Rucker, Workflow would deliver additional time-saving benefits during the procurement process, “especially for activities such as creating POs.”

At the end of the day, though, SSCBR’s investment in Laserfiche comes back to the standard of care. “Patient service is important,” Rucker concludes. “In that, we strive to be like a five-star hotel. Laserfiche helps us to operate more efficiently and effectively, and by accelerating our response to patients, it enables us to increase their comfort level as well.”

Back then, CHMB was struggling to manage a surplus of paper documents so colossal that “we were using filing cabinets as walls and dividers between cubicles,” Anderson remembers. When this elicits chuckles from his listeners, he suddenly gets serious: “It’s funny until it costs you money. And, boy, that paper was costing us a lot.”

The Paper Pit

With over 700 physicians as clients, CHMB currently processes more than two million patient encounters annually—which translates into approximately 10 million documents a year. CHMB breaks the various types of documents down into four different “batches” for processing:

• Charges. Includes superbills, operative reports and patient information.
• Payments. Includes explanations of benefits (EOBs), checks and deposit slips.
• Correspondence. Includes requests for additional information from insurance companies/payors.
• Discrepancies. Includes items that require corrections or more complete information.

“Prior to implementing Laserfiche, we were using couriers to transport materials back and forth between our office and our clients’ practices, and paper storage was consuming valuable work space,” recounts Anderson.

But the cost of managing so much paper wasn’t limited to courier, mail and storage costs; it also extended into employee time and productivity. “Staff had limited access to the paperwork they needed to process, so there were a lot of inefficiencies there,” says Anderson. “And with so much paper coming in and out the door, we were constantly struggling to intelligently manage our workflow; there were just too many moving parts.”

To stop the bleeding, CHMB started looking into content management solutions. According to Anderson, “There are less expensive options out there, but if your system becomes an obstacle to productivity, that’s a problem. We chose Laserfiche because we knew that it would make us more efficient. There was no question about that.”

Serious Savings

With the help of Laserfiche reseller JPI Data Resource, CHMB implemented its content management solution in 2004. Since then, the billing company has been released from its dependence on paper. The volume of paper coming into the office has decreased, since approximately 50% of CHMB’s clients scan and upload their documentation directly to the medical billing company via a secure FTP site. Although the other half of its clients still send paper, CHMB immediately scans the paperwork into Laserfiche and securely disposes of the paper originals after 30 days. “Our shredder stops by twice a week,” says Anderson. “Paper is ugly, and we’re no longer using file cabinets as cubicle walls.”

Laserfiche has also decreased CHMB’s couriering costs by 50%, but the efficiency gains have been even more impressive. “Laserfiche has enabled us to streamline, manage and audit our workflows,” Anderson explains. “Productivity has increased by 20%.”

With Laserfiche, employees have desktop access to all of the documents they need, and data from the system also provides management with a comprehensive overview of the company’s workflow, including:

• Where documents are in CHMB’s workflow.
• Who is working on each document.
• The length of time it takes to process each document.

This type of tracking enables CHMB to measure the efficiency of its workflow and staff. It also enables the company to send reports to clients so that they can quickly identify whether they’ve neglected to send any necessary documentation. As a result, claims are paid faster, clients are happier and CHMB is more profitable.

Unexpected Benefit: Laserfiche Enables a Remote Workforce

According to Anderson, the biggest benefit of implementing Laserfiche is something that CHMB had never even imagined. “When we first bought the system, we had no idea that it would allow us to add 150 employees without relocating or acquiring additional office space,” he says.

Today, CHMB employs a corps of remote workers located around the country who connect to the company’s systems via a secure VPN. To ensure productivity, CHMB created standards and benchmarks for its remote workforce, and the results have been a tremendous success.

“The quality of our staff has increased since we began employing telecommuters,” says Anderson. “We’re able to attract the best people, without geographic limitations, and we find that people who value the flexibility to work from home work harder because they don’t want to lose that perk.”

Laserfiche has also enabled CHMB to offshore certain processes. “We now have a 24-hour workforce,” explains Anderson. “We’re getting work done around the clock.”

Thanks to its increased productivity and profitability, CHMB has been in acquisition mode of late. In September 2008, it acquired a San Diego-area billing company, and in October 2009 it bought a billing company in Orange County. “The first company we acquired was already using Laserfiche,” says Anderson, “so that merger was incredibly smooth. The second company used a different content management platform, so that transition has taken a little more work.”

Overall, “Laserfiche has been a huge differentiator for us,” Anderson concludes. “We’re saving money, we’re more efficient and we’ve added 150 new employees without having to pay for additional office space. Laserfiche is a great product that’s had a huge impact on CHMB and the high quality results we provide for our clients.”

In the past, the organization had a records room for films, reports and patient files, and a number of filing cabinets to store billing-related documents. Although staff had devised a fairly reliable indexing system for each of these items, lost and misfiled documents were a significant problem—and a definite drain on resources.

“Around thirty percent of the time, we’d need a document that was misfiled or ‘temporarily lost,’ meaning that it was probably sitting on somebody’s desk,” Oliveira remembers. “Searches for these documents could take anywhere from five minutes to three days. We had several staff members who became so skilled at hunting down lost documents that we started calling them our ‘sleuths.’”

With an eye toward streamlining work processes and eliminating misplaced paperwork, Central Oregon Radiology Associates developed a plan for digitizing nearly every aspect of its operations. This initiative involved three key components: a picture archiving and communication system (PACS), to store and manage radiological images; a radiology information system (RIS), to manage appointment scheduling, transcriptions and billing; and a digital document management system, to store and manage consent forms, explanation of benefits forms (EOBs) and other documentation.

Oliveira says that selecting the right document management system was one of the easiest parts of this initiative. “Our Laserfiche reseller, JPI Data Resource, did a demonstration at our RIS vendor’s user group meeting, and we recognized that Laserfiche was precisely what we needed. We saw that the system’s security features and auditing capabilities would help us meet HIPAA requirements, and the ability to store documentation electronically fit perfectly with our decision to ‘go paperless’ throughout our organization.”

Staff now scan a number of items—from patients’ drivers licenses and insurance cards to consent forms, EOBs and order-related paperwork—into the Laserfiche repository, where they’re stored as easily-accessible TIFF files. As part of the scanning process, staff apply an electronic template to each file to record the metadata that will be most useful for search purposes. “For registration-related documents, we capture such metadata as the patient’s name, Social Security number and date of birth, as well as the date of service,” Oliveira says. “For billing-related documents, we capture additional information, including the document’s type, the date the document is posted and the batch number.”

Thanks to the system’s search tools, staff can now easily locate relevant documents when patients, physicians or insurers call with questions. Staff also appreciate the system’s “fuzzy” search functionality, which enables them to find documents containing words that partially match the search terms they specify. “These searches are particularly useful when I don’t know the precise spelling of a patient’s name,” Oliveira says.

In addition to its powerful search capabilities, Laserfiche includes a number of other features that help staff work more efficiently. For example, the Quick Fields module minimizes data entry errors by automatically populating template fields with information captured from the document. Electronic redaction tools enable staff to obscure sensitive information, which is especially useful when they need to send EOBs—which typically contain information related to multiple patients—to a secondary payer. “In the past, we’d usually photocopy the EOB form, manually black-out information that applied to other patients, and then photocopy the ‘doctored’ document,” Oliveira says. “Now, we can easily redact this information in Laserfiche, which not only saves time but helps us ensure that we don’t inadvertently release sensitive patient information.”

Oliveira also appreciates the system’s ease of use. “Going digital with our radiological images was quite a hurdle to overcome,” she notes. “After that, Laserfiche was a cakewalk. It’s very user-friendly and easy to learn.”

Oliveira recently transitioned to a new position as the organization’s human resources director, and she notes that Laserfiche delivers the same benefits to the HR department that it’s brought to the rest of the organization. “We manage all of our personnel files in Laserfiche, and we scan payroll and credentialing documentation into the repository as well,” she says. “Thanks to Laserfiche, we have less paperwork to handle, we make fewer photocopies and we spend less time searching for documents. Most importantly, sensitive information is a lot more secure than in the past, when we stored everything in filing cabinets.”

Central Oregon Radiology Associates is currently in the process of upgrading to a newer version of its RIS software; as part of the upgrade process, they’re working with their Laserfiche reseller to integrate this software with their document repository. When the integration is complete, staff will be able to access Laserfiche documents from within the RIS application. “We can’t wait for this integration,” Oliveira says. “The time savings will be enormous, especially for billing-related processes, such as looking up claims.”

Oliveira doesn’t equivocate when asked to describe the benefits that Laserfiche has brought to her organization: “I can state without a doubt that Laserfiche helps us put our energy into serving patients, rather than into searching for lost documents.”

With ten clinics and two in-vitro fertilization (IVF) centers located throughout the greater Chicago area, the Fertility Centers of Illinois (FCI) already had an Electronic Medical Records (EMR) system in place. However, the ArtWorks EMR system only stored patients’ current, FCI-based medical data—historical medical records were kept as paper files, as were lab results, surgery reports and other outside correspondence.

After turning to Laserfiche in order to convert the processing of insurance company explanation of benefit (EOB) reports from paper to a digital system in May 2006, FCI quickly realized that its use of Laserfiche could be expanded to encompass additional medical data—such as lab results and X-rays—that was not stored in ArtWorks. According to Bonnie Kelly, IT supervisor at FCI, “When we switched from paper to Laserfiche for EOBs, the patient account representatives were working with it like veterans by the end of the first day. Over the next several weeks, we saw so much improvement and so few problems that we felt confident that we could move on to patient charts.”

Laserfiche reseller TKB Associates integrated ArtWorks and Laserfiche, working in conjunction with the ArtWorks support team at IntegraMed® America, Inc. (NASDAQ: INMD), FCI’s New York-based national network. “With the integration,” says Kelly, “our doctors have complete access to every bit of their patients’ records, both current and historical.”

In July 2006, the FCI clinic in Glenview began converting its paper charts into digital Laserfiche files. Eleven weeks later, nearly 7,000 charts had been scanned into the system, freeing up enough storage space to create a new nurses’ station.

Quick Capture with Quick Fields

According to Kelly, the conversion process was swift because Laserfiche Quick Fields, a high-volume document capture and processing tool, makes scanning “foolproof and easy.”

FCI knew that it wanted its digital repository of charts to be alphabetical by patient name, with each chart divided into 16 sections, including Demographics, Insurance, Previous Medical Records, Ultrasounds and X-Rays, Lab Results and so on. With the help of Jerry Breitbarth at TKB, FCI used Quick Fields to design a process that accelerates scanning and makes the electronic information readily accessible:

• FCI created a template in the ArtWorks EMR that prints a collection of header sheets for each chart.
• Header sheets contain a keyword (NEWF) that tells Laserfiche it is dealing with a new record.
• Patient’s last name, first name, middle initial, social security number and birthday are printed onto the header. There is a new header sheet for each chart section.
• Quick Fields reads the information off the header sheets and creates a file (including subfolders for each chart division) for each new patient.
• Laserfiche files new charts alphabetically within the folder structure, and files each patient’s documents within the appropriate subfolders in their chart.

This way, people do not have to stop and tell Laserfiche where each page of the chart is supposed to go; they simply print the header sheets, replace the chart dividers with the appropriate header sheets and scan the charts—Laserfiche does the rest.

To date, nine of FCI’s clinics have fully transitioned their patient charts to Laserfiche, with another clinic and the two IVF centers next in line.

Running Smarter

For Tracy Guzman-Barron, administrative services supervisor at FCI, there are three major benefits associated with the company’s Laserfiche implementation:

• Increased information access.
• Enhanced security and easier compliance with HIPAA and other privacy regulations.
• Savings from reduced couriering, storage and paper usage.

First, says Guzman-Barron, “In an emergency, our doctors don’t have to wait around for someone to retrieve a patient’s chart. With Laserfiche, you get instant access.” It’s also next to impossible, Guzman-Barron reveals, to lose a chart in Laserfiche. “Even if something gets misread and misfiled, if it’s in Laserfiche, you can use the system’s search functionality to track it down. That’s not the case when you’re dealing with fifty, sixty or seventy boxes of paper files.”

Second, in terms of data security, “It’s much safer having patient information in a secure, electronic repository than to have paper copies of records lying around on people’s desks,” Guzman-Barron says. “No one can access Laserfiche without a log-in and a password. Even then, everyone’s level of access is tailored specifically to their role and responsibilities. For example,” she adds, “there are only two of us who have the ability to delete.” In addition, Laserfiche Audit Trail tracks and records user activity within the repository. “If anyone is doing anything incorrectly,” Guzman-Barron says, “I can address it with that person right away.”

Third, FCI has experienced a wealth of savings in a number of different areas. “With Laserfiche, we reduced our off-site storage bill by $500 a month,” says Guzman-Barron. “As we scan and destroy old paper medical records, the cost for record retention will continue to decrease.” Documents are shredded after they’ve been scanned into Laserfiche, and several of the clinics been able to convert old storage space into office space as a result. And because electronic records can quickly and easily be printed and mailed or faxed to authorized healthcare providers, FCI saves $50-$75 in couriering and processing costs per chart with Laserfiche.

Furthermore, in these tight economic times, Laserfiche is helping FCI to do more with less. In fact, when the company had an internal reorganization and had to let go of five administrative staff members, it was able to continue doing the same amount of work within Laserfiche thanks to the system’s ease of use. “We used to have seven dedicated staff members who scanned everything into Laserfiche,” says Guzman-Barron. “Now two of us go to the different clinics and train the office staff on how to scan and organize things for themselves. We create centralized templates and standards and then give the offices the flexibility to import files as they see fit.”

She adds, “This isn’t a hard system to learn. I was a novice when I started here in 2007, but it was extremely easy to get into the swing of things. All of our doctors use Laserfiche. It saves us a ton of time, money and frustration.”

Looking Ahead

As FCI gets close to having all patient charts at all of its locations securely stored in Laserfiche, it is planning to expand its system use to various other departments. According to Guzman-Barron, Human Resources will get the next big efficiency boost. After that will come Payroll.

“Laserfiche makes everything easier,” concludes Guzman-Barron. “It’s been a godsend for us.”

“Because it took so long to find charts, we always had a large backlog of lab reports, test results, physicians’ notes and other documents we needed to file,” explains Jo Wells, the group’s operations director. “Physicians would become frustrated because charts often didn’t include the most up-to-date information. Our system clearly wasn’t working.”

The organization’s CEO, Todd Blum, first learned about Laserfiche at a meeting of the American Otolaryngology Association, and he immediately saw that it would help staff manage patient charts more effectively. Laserfiche stores both scanned and electronic documents in a central repository, where they’re immediately available to authorized staff members. To help staff get up to speed quickly, Laserfiche includes a number of familiar Windows features, such as right-click menus and flexible folder structures. Perhaps most importantly, Laserfiche readily accommodates additional users and high-volume repository growth, making it easy for organizations to roll the system out to new users, departments and locations.

Prior to scanning documents into the repository, Wells and her colleagues created a Laserfiche folder structure that mirrors the group’s current filing system. Each patient has his or her own Laserfiche folder, and the documents within each folder are organized by type. “Our paper charts had multiple tabs, such as ‘Demographics,’ ‘Office Notes’ and ‘Labs,’” Wells says. “Because staff already knew which documents appeared under which tabs, we decided to reproduce this structure in Laserfiche. Now, staff simply log in to the repository and browse to the documents they need—it’s like working with the paper chart, only much, much faster.”

When staff add a document to the repository, they also apply an electronic template, in which they record such metadata as the patient’s name, physician, account number and date of birth. They can also use templates to record and track more specialized information; for example, the group created a referrals template to capture each referral’s type, its beginning and end dates, and the number of authorized visits. All this metadata proves extremely useful for search purposes, allowing staff to quickly locate all the documents in the repository associated with a certain patient, physician or account.

Wells notes that Laserfiche not only helps staff and physicians simplify everyday tasks—it also helps them provide even better patient care. When patients arrive for an appointment, front desk staff use Laserfiche to quickly verify that the chart contains all the necessary information, from demographics to consent forms to insurance details. Prior to calling patients into the exam room, nurses use Laserfiche to review patients’ allergies, medical history and current medications. When physicians arrive, they review test results, lab reports and notes from previous encounters; they can also easily highlight important details and add notes for future reference. Finally, billing staff use Laserfiche to review insurance information and encounter details, which helps them promptly generate claims and respond to billing-related questions.

In the next phase of the group’s Laserfiche implementation, staff will begin scanning explanation of benefits forms into Laserfiche, further streamlining the collections process. In addition, physicians will create visit notes directly within Laserfiche, making them instantly available to other providers. And the group plans to expand its use of the Audit Trail module, which monitors all user activity in the Laserfiche repository.

Wells is pleased with everything the group has already accomplished, and she looks forward to continued success in the future. “Laserfiche has definitely helped us become more productive, and I’d recommend it to any healthcare organization. It’s clearly one of the best investments we’ve made.”

Such was certainly the case for Dr. Brian Hanson’s gastroenterology (GI) practice in Ukiah, CA. One of just two GI doctors within a 90-mile radius in rural northern California, Hanson at times may see more than 200 patients a month. He’s a member of several boards and committees, and his practice is affiliated with three different hospitals, two ambulatory surgery centers and two rural healthcare clinics which serve patients in both Mendocino and Lake Counties.

On any given day, Hanson might be found performing outpatient endoscopic procedures, providing acute inpatient gastroenterology services, or seeing patients for consultations at one of the outlying rural health clinics or in his private office. His practice offers patient education programs, educational material, hospital consultations, 24-hour coverage in case of emergency, multiple offices located near local hospitals, and billing.

Stacie Sturges, Hanson’s practice manager, has worked for the gastroenterologist since before he started his own office in 2004. “Dr. Hanson does everything in his power to put his patients first,” Sturges explains, “but staying on top of such a huge volume of paperwork made everything more complicated. Having accurate, up-to-date information at our fingertips is essential, and paper-based records just weren’t getting the job done.

“Before Laserfiche, a simple phone call from a patient triggered a lot of extra work for the office staff,” she adds. “Hunting around for the patient’s paper chart, paging through it to find the relevant information, noting the phone call in the record and then presenting everything to the doctor. It took a lot of time.”

The practice had considered implementing a traditional electronic medical records (EMR) system, but, as Sturges says, “EMR is so complicated. Everyone knows that.”

Indeed, traditional EMR has a number of serious drawbacks, including:

• Prohibitive costs.
• Overly involved requirements for customization.
• Complicated changes to the existing clinical workflow.

The Natural Approach to EMR

Wary of disrupting patient care in service of complex EMR technology, Sturges discovered a more natural solution to the practice’s information management challenges one day while reading Healthcare IT News: “I saw an ad for ‘document management’ and I knew that this was what we desperately needed.”

Best-in-class content management software—with its ability to digitize, organize and store content from across the entire practice—is being adopted by many small medical offices that want an affordable and easy-to-use alternative to traditional EMR. These “hybrid” solutions (so named because they combine content management with other applications such as practice management and e-prescribe) provide a simple, centralized and secure means of managing patient records without complicating the clinical workflow.

“Most doctors’ offices like ours do not have an IT expert in their back pocket,” explains Sturges. “The fact that Laserfiche is so user friendly made it very appealing to us.”

In December 2008, Hanson’s practice purchased and installed the Laserfiche Avante suite from Laserfiche reseller AMI – The Paperless Company. In less than one week, AMI had installed the software and hardware and trained Hanson’s staff. According to Sturges, Hanson’s practice is using Laserfiche to “make our own EMR.”

In terms of the installation process, “The guys at AMI were awesome,” says Sturges. “They listened to what we had to say and organized our solution in a fashion that matched the way we wanted to work. Most importantly, our transition to a paperless office was effortless! The install was completely smooth.”

Today, with Laserfiche and three Fujitsu FI 6140 scanners in place, the office is running like a well-oiled machine. Hanson carries his Fujitsu Tablet PC wherever he goes so that he has real-time access to patient information. This enables him to immediately respond to issues that need attention instead of waiting to get back to the office and dealing with a pile of paper charts.

Technology that Adapts to the Practice

The more closely a software solution mirrors the day-to-day realities of a practice’s working methods, the more likely it is to deliver value. Sturges appreciates the flexibility of the Laserfiche solution, stating, “This isn’t one of those cookie cutter systems that you have to conform to. Most doctors like making their own decisions, and they don’t like being told what to do. Laserfiche allows them to decide how they want to work.”

Hanson’s practice has configured Laserfiche to handle a number of patient-related tasks, including:

• Storing scanned records. The folder structure in the Laserfiche repository is organized by patient. Each patient has a folder that contains subfolders for test results, surgical procedures, X-ray information and so forth. This keeps the information organized and easily accessible by authorized employees.
• Automatically routing information. Using Laserfiche Workflow, test results and other important patient updates are automatically sent to Dr. Hanson as soon as they are entered into the system. This speeds Hanson’s response to patients and saves staff time.
• Rapidly processing records. Hanson’s office has customized the document templates in Laserfiche Quick Fields by adding a status field that enables staff to quickly and easily identify urgent messages, call backs and real-time progress notes. In addition, automatic information capture and indexing cuts down on manual data entry and gets information into the system swiftly.
• Facilitating compliance. Laserfiche Audit Trail ensures information security and simplifies regulatory compliance. Hanson’s practice uses it to stay HIPAA-compliant by following the flow of information, keeping track of changes and noting what needs to be done next.

To Sturges, this is a clear-cut case of technology adapting to the flow of the practice, rather than the other way around. “We don’t need all the bells and whistles associated with traditional EMR,” she says. “Laserfiche has been a ‘meaningful use’ solution for us because it gives us exactly what we need to manage our office and improve patient care.”

Passing the Benefits Along to Patients

For Hanson’s practice, Laserfiche has decreased the costs associated with storing and handling paper records, ensured the safety and accessibility of those records, and increased the efficiency of the practice’s day-to-day operations and employees. Some of the chief benefits of the system include:

• Comprehensive search functionality allows staff to locate records within seconds.
• Remote access to the Laserfiche repository over a secure private network (VPN) gives Dr. Hanson the ability to instantly locate and amend records without pulling other staff members away from their jobs—even when he’s not in the office.
• Multiple people can access the same digital record at the same time.
• No electronic records ever get lost.

All of these benefits, however, would be meaningless if they didn’t ultimately enhance the quality of patient care.

“Providing top-quality care is of the utmost importance to Dr. Hanson,” says Sturges. “We’re always asking ourselves, ‘How can we better serve this patient?’ Many of them are facing really difficult decisions regarding their healthcare. They deserve answers, and they deserve them quickly. With Laserfiche, we coordinate care much faster because patient information is so much easier to find.”

For the people who struggle with these issues in southeast Texas, Spindletop Mental Health Mental Retardation (MHMR) Services has the resources to support their recovery and relieve their distress. But with over 8,000 patients every year and upwards of 400 employees, Spindletop’s ability to respond promptly to records requests—and, by extension, to patients—was being compromised.

Over 80,000 files resided in a hardcopy storage facility that cost more than $2,000 a month to maintain. And even with six full-time staff members dedicated to managing hardcopy documents, some records took as long as three days to locate and cost $4 each to retrieve and deliver; others were lost for good.

Realizing that an enterprise content management system would ensure access to high-quality services in a more cost-effective way, the center turned to Laserfiche for help.

Complete Content Management within a SharePoint Site

Spindletop was already leveraging SharePoint for the company’s intranet site, but scanning and storing 80,000 documents in SharePoint required more comprehensive content management functionality.

“We wanted to centralize access to patient records without forcing our employees to go out of their way,” explains Jerry Carnley, CIO at Spindletop. “Our intranet seemed to be the natural place to do this, but we needed to implement a content management solution that would be easy to implement, easy to install, and eliminate extra work for the people who deal with patient documents every day.”

Spindletop selected an Agile ECM system engineered with Laserfiche and SharePoint, which met its content management needs in three key ways:

• Seamlessly added document imaging functionality to SharePoint with minimal requirements for installation, support and maintenance.
• Dramatically expanded the amount of content that can be stored online while also improving document security.
• Provided federated search across content stored in Laserfiche and SharePoint.

“Given Laserfiche’s experience and dedication to the Microsoft suite of technology, we saw that it delivers a complete offering to customers seeking an integrated content management and SharePoint solution,” Carnley says.

Specifically, Agile ECM engineered with Laserfiche and SharePoint enables Spindletop to:

• Bring comprehensive document imaging and records management functionality to Spindletop’s existing SharePoint intranet. Employees scan and upload documents directly through the SharePoint interface, then view and manage them with the easy-to-use Laserfiche document viewer.
• Supply superior security, records management and content distribution capabilities when content is moved between SharePoint and Laserfiche—manually, as part of a workflow process or automatically based on a SharePoint expiration policy.
• Provide the ability to retrieve content from both Laserfiche and SharePoint using Spindletop’s intranet search box.
• Automate content-related processes based on activities occurring in both SharePoint and Laserfiche with graphical, drag-and-drop .NET-based workflow configuration that makes workflow design simple for IT staff.

As a whole, Agile ECM provides a cost-effective complement to Spindletop’s SharePoint intranet site—with all of the content management capabilities the company needs.

Results of Running Smarter

With the assistance of DynaSource, a Laserfiche reseller located in Texas, Spindletop implemented Laserfiche and transformed the way it manages content, most notably in the four following ways:

• Instant search and retrieval. From any internet access point, staff can instantly locate scanned records by using the “Electronic Imaging” tab on the SharePoint intranet site. Offsite employees have
  access to the Laserfiche digital records repository through a password-protected Citrix site.
• Sure-fire security. Because Spindletop’s SharePoint intranet uses full Laserfiche security enforcement, employees are granted access to records by department. Employees can view the records for their
  own clients, but restricted patient, employee and financial information remains confidential.
• Easy and efficient scanning. Laserfiche templates enable employees to scan ten times more content than they could before the custom templates were implemented.
• Time-saving automation. When new content is scanned into the system, Laserfiche automatically populates template fields and generates and organizes new folders and subfolders. Because each client has between six and eight subfolders with a total of 25-52 documents to be scanned, this eliminates redundancy and extra work.

According to Carnley, implementing Agile ECM has had a number of noteworthy benefits. “We’ve increased productivity, and morale has jumped in every department that uses Laserfiche,” he says.

“There’s no more waiting around for days for hardcopy documents to be found, and no more lost or misfiled records resulting in huge institutional fines. And we aren’t spending thousands of dollars each month on offsite storage facilities,” Carnley adds.

But best of all from Carnley’s perspective as a CIO is that because Agile ECM engineered with Laserfiche and SharePoint supports developers who need to extend collaboration, scan images and set up workflows to quickly respond to business needs, deployment was quick, easy and affordable. There was no need to hire expensive programmers or IT consultants and no need to build customized plug-ins from scratch. In addition, the intuitive user interface makes the solution easy to administer, since drag-and-drop functionality enables IT staff to permit line-of-business employees to easily make changes to existing workflows and folder trees without IT staff assistance.

“Laserfiche provides a scalable solution that’s easy to install, easy to administer and easy to use,” concludes Carnley. “We’re very happy with the way Laserfiche has enabled Spindletop MHMR Services to expand our use of SharePoint and improve the way we manage content.”

That’s BC Biomedical’s motto. And since implementing Laserfiche four years ago to manage its sprawling information network spread out over 47 patient service centers (PSCs), you can add “embracing technology” to its motto.

Headquartered in Surrey, British Columbia’s second-largest city, BC Biomedical (BCB) has been privately owned and operated by laboratory physicians since Dr. C.J. Coady founded it 50 years ago. In its half-century of existence, BCB has grown to comprise more than 40 leading practitioners in all disciplines of laboratory medicine. BCB’s pathologists are among Canada’s top practitioners in their fields, and their model for health care and community service is recognized and respected worldwide.

BCB’s service centers rely on Laserfiche to manage a broad range of documents, explains Business Systems Analyst/Project Manager Chris Fiorucci . “We have more than 700 employees, administer 440 types of tests, and see about 6,000 to 8,000 patients daily, so we desperately needed a document management system that would enable us to store and retrieve vital patient information instantly and across our multiple centers,” she says. “Laserfiche is our lifeline.”

Because Fiorucci has worked with BC Biomedical for 38 years, she knew how important a strong family feel is to her organization. BCB, in fact, has been voted one of Canada’s 50 Best Employers for seven consecutive years according to Hewitt Associates Annual Study. So when BCB first looked into Laserfiche, they knew they’d discovered an organization with values that mirrored their own. “We pride ourselves on our commitment to our patients and community,” she explains. “Laserfiche shares our core values. Their community focus and strong software product are a winning combination.”

But if BCB’s great to work for, it’s also great to be one of its patients. BCB’s commitment to its patients is embodied in its core values of delivering quality service, maintaining professional and ethical business practices, and being responsible and accountable for actions. “Above all, we’re dedicated to providing diagnostic health care of the highest quality to our patients. We respect each other and work together effectively and relentlessly to constantly improve. Laserfiche is in line with our goals, and with 47 patient PSCs, we rely on Laserfiche to sustain operational efficiency and flexibility,” Fiorucci explains.

BCB made its name developing timely, meaningful diagnostic information for physicians and responding to patient needs for laboratory services. As services spread across British Columbia, that benchmark of the BCB brand became more and more challenging to maintain. Pre-Laserfiche, an office would receive one patient requisition form at a time that then needed to be physically stored at the PSC for three months before being sent to offsite storage for at least another six years. “The paper trail was huge, and the storage costs came to a pretty penny,” Fiorucci says.

BCB’s goals were to decrease photocopying, eliminate off-site storage, automate printing of requisitions for send-out tests, reduce costs and improve efficiencies, while adhering to the Canadian Medical Services Commission’s (MSC) Electronic Storage of Requisitions—all of which and then some have been met since implementing Laserfiche in 2004.

The main Surrey office uses an area setup exclusively for three scanning clerks to onboard the approximately 10,000 patient requisitions delivered daily. “We no longer need to photocopy requisitions,” Fiorucci says. “With access to the on-line patient requisition repository using WebLink, we’re truly paperless.”

The Surrey office houses human resources, finance, and business account teams for non-medical testing. “With so many PSCs and branches, Laserfiche is essential for our internal communication and business continuity,” remarks Fiorucci.

And besides improving communication, BCB eliminated more than 25 hours a day spent filing original documentation, retrieving information and re-filing, and faxing or mailing documents—not to mention all the time wasted trying to find misplaced documents.

“The old way of doing things around here was extremely time-consuming and ineffective, especially when you would get phone requests for additional information. It definitely took staff time away from our patients,” Fiorucci says. “We now have a total turnaround time of four hours because Laserfiche has helped us multitask across several departments. I cannot stress enough how reliable, fast and easy the system is. Laserfiche has impacted our entire organization in a positive manner.”

More recently, BCB was the first user to implement the beta version of Laserfiche Bar Code 2-D. Now, after a patient request is received, staff use the lab information system to print out bar code labels containing PSC information such as the request number, patient’s first and last name, personal health number (PHN) and service date. Patient and barcode labels are placed on the patient’s requisition and a scanning clerk then picks up all requisitions for scanning.

In order to automate work processes even further, BCB’s developers were able to take the request number scanned into Laserfiche and look up the patient request number in the lab information system to determine if any of the tests ordered needed to be sent to a different testing facility. “If they do, another program runs to retrieve the image from Laserfiche and prints it on a printer in central processing,” Fiorucci says. “This was definitely a win-win situation for all of us.”

Additionally, departments can now view patient requisitions online, which streamlines procedures such as phoning the PSC for test confirmation of doctor information and diagnosis. “As a seasoned BCB employee I can tell you that life after Laserfiche is greatly simplified!” Fiorucci says. “Now that we’ve improved office efficiency, we can focus on our goal of advancing health one patient at a time.

“Implementing Laserfiche was the best decision we ever made,” she adds. “We’ve reduced wasted office space required to store forms, saved time retrieving documents, saved money storing documents offsite, and more importantly streamlined our workflow processes enterprise-wide.”

Bill Long, MultiMed’s CEO, recalls his first thoughts upon hearing the news: “Of course, my first concern was my staff’s safety. But after I learned everyone was out of the building, I started thinking about what we’d need to do to get back up and running. I wasn’t in panic mode at all, thanks to of our disaster recovery plan. “

The foundation of MultiMed’s disaster recovery plan is their Laserfiche digital document management system. MultiMed staff immediately scans all incoming paperwork into the Laserfiche repository, where it’s automatically indexed and securely archived. Routinely scheduled in-house and off-site backups preserve documents’ integrity and ensure their future accessibility. “There’s nothing more important to us than making sure our clients feel safe with their information in our hands,” Long says.

That information includes pre-hospital care reports, checks and explanation of benefits (EOB) forms, so MultiMed must focus on protecting patient privacy, in addition to providing their clients with peace of mind. “It’s not just for compliance purposes,” Long explains. “From a moral standpoint, it’s the right thing to do.”

While Laserfiche has ably addressed the company’s disaster recovery concerns, MultiMed staff had realized the benefits of Laserfiche long before the fire. The company’s efficiency gains have been especially dramatic: Long estimates that since implementing Laserfiche, MultiMed has increased efficiency by 20% while controlling labor costs and dramatically reducing other overhead costs.

Says Long, “For any business, the benefits of going paperless are easy to see. There’s no more getting up, walking to a file cabinet, looking for a file and bringing it back to the desk when a client calls. We can bring up all our information instantaneously.”

Many medical billing companies have accelerated collections with Laserfiche, and MultiMed is no exception. Whenever a supporting document enters the Laserfiche repository, Laserfiche Quick Fields™ automatically files it to the appropriate folder, either by reading a bar code or by recognizing particular text printed on the document. The result? All documentation relating to each claim resides in the same folder, so staff can access whatever information they need in order to process a claim, whenever they need it.

Laserfiche’s integration with MultiMed’s primary billing software makes accessing information even easier. Staff employ a dual-screen setup—one monitor displays their primary software, the other shows the Laserfiche repository. Bringing up a pre-hospital care report in the primary software instantly retrieves all supporting documents from Laserfiche, then displays them side-by-side with the billing application. In addition, Laserfiche automatically assigns metadata to all future associated documents originating from the billing application, enabling staff to locate documents in a number of different ways.

Still, all of these enhancements would be for naught if MultiMed was caught without a comprehensive disaster recovery plan.

“We did an event synopsis after the fire,” Long explains. “We saw that even if the building had been completely leveled, all of our information would have been backed up, right to the minute of the event. We could have been back up and running within a day, two at the most.”

When asked to speculate on how long it might take to recover if the worst happened and MultiMed was without its Laserfiche system, Long answers flatly, “I don’t know if we would ever be back in business.”

Crisis averted, Long is beginning to think about additional ways Laserfiche could help with disaster recovery—specifically, if such a disaster were to occur at one of his employees’ homes.

“I’d like to offer all employees their own personal folder in the company Laserfiche repository,” he says. “That way, they could preserve all their own vital documents if something should ever happen in their personal lives. It would be a great added perk.”

Future plans aside, Long appreciates the peace of mind that Laserfiche offers every day. “We’re in the medical field, but every business has shared concerns, and similar documents to protect—invoices, HR files. It’s important to be prepared for anything. Laserfiche’s disaster recovery features have been like insurance—you hope you never need to use it, but if anything does happen, boy, are you glad you’ve got it.”

“Ignorance of electronic document management is costing medical groups millions of dollars in extra payroll costs and hurting the morale of office staffs,” Lafayette said. “It is relatively easy to demonstrate immediate return-on-investment (ROI) for converting traditional files to electronic images to practice administrators; I have numerous references ready to share their successes, too.”

Lafayette said most medical practices began introducing automated billing and scheduling software within the past 10 to 15 years. Many have since introduced electronic medical records systems (EMRs) as well. But the key to streamlining offices staffs and improving productivity is to tie those technologies together with Laserfiche, a sophisticated electronic records management system enabling office staff to access all stored records on their computer desktops.

Physicians Support Group next intends to launch a regional educational program to show medical practices how to use technology to improve operations. Lafayette is planning an ambitious campaign throughout the Sunbelt to advise specialty groups how to securely convert every paper document, including patient identification, explanations of benefits, “superbills” (which itemize all services, diagnostic and medications) and medical records, into searchable electronic records.

“My goal is to show that creating the ‘ideal medical practice’ is within the grasp of any group willing to employ today’s technology.” Lafayette said. “This will allow physicians to devote their full attention to patient care, reduce the number of support staff while improving the morale and productivity of those processing documents for payment and eventual archiving. This is really a win-win for medical groups.”

Many medical groups around the nation have in recent months explored and selected Laserfiche for compliance with federal HIPAA (Health Insurance Portability Accountability Act) requirements, according to Stephen Wheeler, Laserfiche’s National Health Care Sales Manager. Laserfiche’s advanced security features are critical in that regard, but Wheeler said integrating document management with other office automation products provides the comprehensive solution required in today’s health care market.

Lafayette’s ROI calculations factor in Laserfiche’s ease of installation and short training cycle, which means workers become quickly productive when using the software. The Laserfiche intuitive interface, combined with its filing structure which mirrors traditional filing methods, make immediate sense to workers.

“Clinic administrators like the idea of replacing copiers, which spew thousands of pieces of paper a day, with affordable scanners, which generate electronic images for paperless files,” Lafayette said. “Once an electronic file is created, it is stored on a hard drive, where it can’t be lost and can be immediately retrieved without time-wasting trips to dusty file rooms. And all electronic records can be backed up and stored off site, providing desirable disaster recovery requirements.”

Then they got Laserfiche.

“You can’t imagine how much time this saves us,” says Medical Records Supervisor Brenda Glover. “Four hours a day, at least.”

That’s because the Stanford Blood Center is not your average blood bank and the people who donate there are not your average donors. Each year, tens of thousands of donations are made there, many by donors who extend their arms for others up to a dozen or more times a year.

The Blood Center’s donors are dedicated donors who often give just a portion of their blood called the platelets, which are vital for cancer victims undergoing chemotherapy. With the platelets removed, the rest of the blood is returned to the donor’s body, enabling them to donate again much sooner than if they had donated whole blood. Some of them have donated up to 500 times, according to Glover, who has donated her own blood 68 times.

“For a blood bank to be a success, it has to have repeat donors,” Glover says. “These donors are very dedicated, and they are usually back within one or two weeks.”

Unfortunately, this act of charity comes with a price: paperwork, and lots of it. The Blood Center can’t determine if it’s safe for a donor to give without knowing first a lot about that individual’s health history and past donations.

Each donation requires filling out a history card, whether it’s an individual’s first or fiftieth time at the Blood Center. These cards provide vital details which may affect an individual’s eligibility to donate. Staff then have to make sure that information is complete and has been reviewed by the medical professionals drawing the blood before any donations can be collected.

Before Laserfiche, paper history cards were filed in Glover’s office. Whenever a repeat donor came into one of the Blood Center’s collection locations, Glover’s staff had to pull that individual’s file down, package it, deliver it and then pick it again at the end of the day. They went through the same process even when there wasn’t a donation being made, such as when a doctor just needed to update a file, investigate past donations or double check information.

“Then there are the calls we’d get every day looking for special requests for these documents just for history information add-ons,” Glover says. “It was just a big, long drawn out process for each donation.”

With 55,000 to 60,000 donations annually, Blood Center staff spent much of its time hand-delivering paperwork around town. The Center bought its Laserfiche license and had the software installed last year, but needed a new server to really get up and running.

When that server arrived this year, all the Blood Center’s computers at remote collection locations were networked into the Laserfiche system at on-campus headquarters. Since staff began scanning all new history cards and back-scanning the old ones, they’ve begun to realize the labor savings tens of thousands of Laserfiche customers across the country have enjoyed for years.

Donor documents scanned into Laserfiche are now instantly available for nurses in the satellite offices through a password-secured Website. When a donor walks into one of the remote locations, a number assigned to his or her file is typed in and the person’s entire donation and health history is instantly available.

“We’re no longer pulling files down and putting them into a bucket to be sent out to the donor locations,” Glover says. “And we don’t have to wait for the charts to return or wonder where the charts we’ve already sent out are. If a doctor needs a chart right away, we’re not scrambling around. Thanks to Laserfiche, doctors can access these charts without any waiting.”

This is particularly helpful, Glover says, when it’s discovered after a donation is made that reporting inconsistencies on the history files should have disqualified a donor. Time is a factor in such cases, and accessing information instantly is a huge help. Staff can also scan documents from histology department and e-mail the images immediately if the Blood Center’s director is out of the office and in need of information.

Once the cards are scanned into the system and the images are inspected for accuracy, the hardcopy is sent off site and eventually destroyed, so Laserfiche is not just freeing up time, it’s also freeing up space.

So, what is Glover doing with all her free time now that the Blood Center has Laserfiche? What every other Laserfiche customers does once they’ve got their system in place—expanding its use into other areas of office operations.

“Soon we’ll be moving into employee records, machine maintenance records, and contracts procurement,” she says. “Anything that can be filed into a filing cabinet will be going into Laserfiche.”

“Within our storage area,” recalls Dubon, “you frequently had to move a lot of boxes out of the way to get the one you wanted. If they were overhead, you had to call someone to help you. With boxes that heavy, it would be really easy for someone to get hurt. It was a worker’s comp claim waiting to happen, which would not only mean injury for an employee, but also an unnecessary expense for the department.”

The department’s storage space filled up quickly, so Dubon was forced to rent off-site storage space, an added expense for the department. “Someone would have to carry boxes out and transport them off-site” says Dubon. “Even if I decided to spare an employee’s effort, I’d have to hire a courier, so that was another expense.”

With the goal of freeing up storage space and protecting her staff’s time and health, Dubon began looking at digital document management solutions. She relied on Systems Analyst Nelson Munguia to do some initial investigation. He looked at four products, with an eye toward reducing necessary storage space, minimizing data latency, providing easy retrieval of information and spending funds wisely. “We were looking for something that we could implement without increasing the staff workload and that would give us easy access to the data,” says Munguia.

“I really needed something that would be HIPAA compliant. That was my number-one priority,” adds Dubon, whose staff is required to protect confidential information contained in billing and Explanation of Benefits (EOB) forms.

With the help of reseller American MicroImaging, Inc. (AMI), Munguia narrowed the choices to two. After a Laserfiche® demonstration, Dubon was sold. “We could see how easy it was to use,” she says. “It’s a very user-friendly system.” Dubon made the decision to outsource the scanning of older documents to keep her staff free for day-forward scanning and locating documents using the new system.

Munguia recalls, “It took about two months to complete the installation of the server and scan six months worth of documents.”

Within a week or two of installation, the Laserfiche system was up and running, solving the problem of searching through boxes in the storage space. Instead of hefting bulky boxes to find documents, staff just calls them up on their desktops. “It took a huge headache away from me and my staff. It’s just easy—you can take something like an EOB and e-mail it to someone, or print it and mail it. We’ve eliminated the lag time for each collector.”

Laserfiche also eliminated misplaced files and batches of files. “Nothing is misfiled anymore,” says Dubon. “If we have an issue with something not being in a batch, which happened before we had everything fine-tuned, we resolve it right away. But now I don’t find that anything’s missing.”

Dubon even finds that Laserfiche can save patients some grief. “If a patient calls with a problem—for example, ‘My secondary insurance hasn’t paid’ or ‘I’ve been billed for charges that aren’t mine’—we don’t have to tell the patient that we’ll call them back the way we used to when it took so long to search for files. We can locate the file right from our computers and see the problem. That saves the patient a lot of worry.”

Locating EOBs quickly, whether there’s a mistake or not, saves Dubon from having to hire additional staff. “If I didn’t have Laserfiche, I would have had to hire someone full time to pull all those EOBs. I don’t have to move to pull files anymore. I just move my fingers to access the system and it takes seconds.”

Because the department uses Laserfiche, charges rarely get posted to the wrong account. “That would happen all the time in the past,” recalls Dubon, “and it was a big effort to correct. Now we’re doing more of an electronic interface for charges, moving more toward being paperless, so that’s happening a lot less—and it takes a lot less time to correct. Before installing Laserfiche, it could take up to two hours just to find the invoice. Now it takes seconds.”

Radiology needs to share patient data with other USC departments that also use Laserfiche, particularly demographic and insurance data, but they also need to protect sensitive information. That’s why HIPAA compliance was so important to Dubon. And Laserfiche security features enable her to control access to confidential data.

“AMI helped get everything up-to-date—I could set the access controls so that only authorized people have access to sensitive information,” says Dubon. While other departments use Laserfiche for many reasons—for example, USC also uses Laserfiche to manage clinical data—staff in those other departments may not have the proper clearance to view confidential information. “When we send out files to other departments,” she continues, “we frequently use redaction to block sensitive information, such as charges or the reason a patient came to see the doctor.”

Munguia appreciates the reduced turnaround time between service and payment, as well as the reliable backup that Laserfiche provides. He sees an added benefit as well, noting that timely document delivery no longer stresses out staff. “I notice it every time we get a subpoena for medical records. Localization of documents is no longer a chore. Staff is smiling and they don’t look menacingly at the process servers anymore.”

Munguia first installed Laserfiche in the billing department. Accounting was so impressed by what the software could do that they soon followed suit. That department is now looking into expanding its use beyond auditing to creating accounting reports. Munguia looks forward to adding the administrative staff to the growing list of Laserfiche users.

There’s no doubt that Laserfiche has smoothed operations at USC Radiology. Dubon notices that in addition to sparing the staff heavy lifting and making their jobs easier, it’s also helped the department respond more quickly to patient requests. The installation is so successful, in fact, that AMI uses it as a demonstration model for potential customers.

Says Dubon, “The system is never down, it doesn’t have glitches and whenever something is not scanned properly, we’re able to flag it right away. I am very, very happy with it. It’s probably the best thing that my boss ever allowed me to do.”

The SurgiCenter performed its first procedure on May 22, 1989, and hasn’t stopped since. “We have 100 doctors and 35 staff members working together to provide superior patient care, with over 20 procedures performed on an average day,” says Jeffery Johnson, systems information specialist. “That creates a lot of information to manage.”

Relying on paper patient charts, however, was limiting staff’s ability to efficiently share that information. “Too many people needed records simultaneously, including clinical staff, the billing department, auditors and the medical records technician, who needed to file reports that came in days later,” Johnson says. “Staff didn’t take the process seriously, and there were constant filing errors.

“Around 30 charts per month were checked out just for auditing by anesthesia and nursing staff,” he continues. “If the charts were unavailable or incomplete, the billing department couldn’t do their work. And to make matters worse, we were more successful than expected—over a five year period, our case load grew from 5,300 to 8,600.”

Too much success is a nice problem to have, but the SurgiCenter faced its biggest challenge in managing paper patient records. The cost of storing records was rapidly increasing, and keeping up with records retention requirements was a burden. “Offsite storage was 5 miles away, so we were paying to store the records and wasting man-hours to retrieve them,” Johnson remembers. “Even before HIPAA passed, we knew we couldn’t maintain records integrity and patient confidentiality with paper records. We knew something had to be done.”

Staff initially considered implementing an electronic medical record (EMR) system, but rejected the idea because commercial systems didn’t meet the SurgiCenter’s needs. “As a surgery center, we typically only see a patient two or three times, so we didn’t need the functionality of a traditional EMR—not to mention the expense,” Johnson says. “We knew we needed to move to electronic record keeping, however, so digital document management seemed to be an ideal solution. We could eliminate paper, secure our records and easily locate information, which was just what we needed.”

When Johnson took over the medical records department in 1996, he agreed to manage HIPAA compliance only if he could deploy a digital document management system. “We experimented with another product that didn’t scan efficiently, wasn’t user-friendly and had poor retrieval capability,” he explains. “The clincher came when the manufacturer phased out the application, and they wanted us to purchase their replacement product. That’s when I began researching other document management applications and found Laserfiche®.

“We selected Laserfiche because we needed a solution employees would learn quickly,” Johnson continues. “We liked the quality of the scanned images, and the processing speed was superior. We also liked that we could run audit reports for accountability. Laserfiche had everything we needed.”

Implementation went quickly, with the repository going live after only one month of testing. “We initially scanned in three years’ worth of records,” Johnson says. “In phase two, we scanned another four years’ worth of records—about 31,000 medical records in all.”

Currently, the SurgiCenter uses Laserfiche to streamline workflow throughout the life cycle of patient records. When a patient pre-registers, staff create a paper chart that includes a bar-coded face sheet. After the patient’s procedure, they scan the chart into Laserfiche, using Quick Fields™ and Bar-Code Recognition™ to automatically create the digital patient record and populate each document’s template fields, simplifying indexing and chart retrieval.

The SurgiCenter’s billing department also uses Laserfiche to manage explanation of benefits (EOB) forms. Quick Fields automatically fills in the payor and date for each EOB in the associated template, which aids in tracking and retrieval. “Laserfiche has brought greater efficiencies in all departments, but especially in Billing,” Johnson says. “We’ve seen much faster claims processing and collections.”

Perhaps most importantly, Laserfiche helps the Center remain compliant with HIPAA regulations. “With Laserfiche, we can log in requests for records, track due dates and redact sensitive information, fulfilling release of information requirements. We also use the Audit Trail™ module to safeguard patient privacy,” Johnson explains. “Our administrator serves on a national HIPAA compliance panel, and she frequently invites confused hospital administrators to see how Laserfiche helps us meet these challenges.”

The Center also must remain compliant with Association for Ambulatory Health Care (AAHC) regulations. The AAHC conducts on-site evaluations every three years, and audited the SurgiCenter just a few months ago. “We passed with flying colors,” Johnson reports. “In a typical audit, they request random charts, but on this last audit, they got very specific, requesting two charts of patients who were also Wards of the State. This isn’t information we track, so it would normally be very difficult to find.

“Thanks to Laserfiche’s full-text search capabilities, we located these charts very quickly,” he continues. “The auditors also requested charts of cancer patients, which we found just as quickly. Needless to say, they were duly impressed.”

Laserfiche also helps the SurgiCenter easily complete state-mandated quarterly pathology reports of cancer quantities, broken out by type. “As you can imagine, this data was quite difficult to flag and track with paper, but with Laserfiche, the staff person simply searches on the specific cancer—like melanoma or carcinoma—for the relevant time period, and the results are right there almost instantly,” Johnson says.

The best thing about Laserfiche, according to Johnson, is that the Center can manage patient records with fewer staff members. “Before Laserfiche, we had separate departments for surgical scheduling, patient registration and medical records. We’ve merged the three departments and eliminated the medical records clerk position,” he says. “We originally had three scanning clerks, and when one left, not only did we not have to replace her, but the remaining two were able to take on scheduling and records management duties. We’re now down to a single full-time scanner.”

But Laserfiche has delivered more than easier compliance, faster reporting and staffing efficiencies. “We’ve had a lot of benefits that we didn’t expect,” Johnson says. “We used to have constant friction among departments who needed the same records or who were looking for missing records, but with Laserfiche, everyone who needs a chart can always find it. It’s dramatically improved the working relationship between departments.”

Johnson doesn’t hesitate in recommending Laserfiche to other ambulatory surgery centers. “In practical terms, we’ve reduced costs, improved collections and established peace of mind when it comes to record keeping,” Johnson says. “You can’t go wrong with Laserfiche.”

Processing the thousands of paper documents associated with these accounts, however, was limiting MDS’s productivity. “We needed a system to provide three key features: security, accessibility and accountability,” says Solutions Architect Matt Brown. “We also wanted to cut down on paper-related costs. We spent the better part of a decade looking for a system that could accomplish all these goals.”

MDS first experimented with a Web-based product in an attempt to eliminate paper documents and streamline work processes. “It did a very good job of storing and retrieving documents, but that was about the extent of its usefulness,” Brown says. “It proved difficult to administer. So we then built a second system ourselves, using Microsoft® SharePoint® as the foundation.”

This second solution provided a clear demonstration of the benefits of an enterprise-quality system. “We could see the possibilities, such as ease of retrieval, improved business intelligence and the efficiencies of automating work processes,” Brown explains. “However, SharePoint isn’t a document management system, so we were asking it to do something it wasn’t designed to handle.”

This experiment, however, helped staff envision an ideal solution. “Our immediate goal was to store billing records electronically, but our eventual goal was and still is a completely paperless workflow,” Brown says. “We needed to make sure that billing records were easily retrievable, that protected health information was secure and that we could account for all our documents, but we also needed a solution that was cost-effective and scalable.”

Laserfiche® fulfilled all these requirements—and more. Thanks to its open architecture, Laserfiche can serve as the document management back-end for many line-of-business applications, including Med/FM™, the application MDS uses to manage billing and claims processing. With help from their Laserfiche reseller, JPI Data Resource, MDS integrated the two systems so that staff can instantly access Laserfiche documents from within Med/FM. “That was the system’s number one selling point,” Brown notes.

After MDS selected Laserfiche, things moved quickly. “Installation was completed in less than a day, and training took less than a week,” Brown remembers. “We were able to initiate a completely paperless workflow for one of our clients by the week’s end. Then we started bringing our other clients online.”

MDS has two Laserfiche servers, one in each of their two divisional offices. Over 30 users in those locations—and in smaller offices throughout California—use the system daily to process billing documents submitted in both paper and electronic formats.

Some clients still send MDS paper billing documents, which must be processed manually. Staff scan those documents, separated by bar-coded index sheets, into Laserfiche. The Quick Fields™ Bar Code Plug-In™ reads the bar codes and automatically indexes the scanned files. “We simply attach the cover sheet to its corresponding billing record and Quick Fields does the rest,” Brown says. “Quick Fields fills in all the necessary document metadata—such as the patient’s name and identifying information—that is stored in the bar codes.”

When clients submit electronic documents, staff use the client’s daily log to create empty documents in the Laserfiche repository that serve as place holders for corresponding billing documents. Staff then use Snapshot™ to convert the electronic information into unalterable TIFF files and import them into Laserfiche, where they are matched up with the empty documents created earlier.

To further automate work processes, Workflow™ routes documents among the various departments that create the billable record and generate the final claim. If any information is missing, Workflow automatically routes the record to the appropriate department for further follow-up.

While Laserfiche speeds up the entire collections process, it has specifically streamlined the process for submitting claims that require supporting documentation. “Before Laserfiche, there was a delay of several days, given that a staff member would have to physically locate the billing record, pull it and copy it,” Brown says. “Now, we can send claims out the same day. Employees simply pull the account up in Med/FM and press a function key, which automatically generates a search in Laserfiche for the patient’s billing record.

“These efficiencies have enabled us to shift job priorities from one department to another—or eliminate tasks altogether,” Brown continues. “Before, we needed a rather large staff just to manage all the paper. Our medical records department has been completely transformed. Now, they simply handle scanning and document printing for claims attachment.”

In addition, Laserfiche has given MDS greater oversight of business processes. “We use Microsoft SQL Server™ Reporting Services to query the Laserfiche database, which provides us with a wealth of real-time data we didn’t previously have access to,” Brown says. “This data gives us greater awareness of our business processes, which helps improve decision-making.”

MDS’s clients benefit from this improved reporting as well. “The medical director at one of our client sites requests a monthly time study showing how many patients their physicians see each hour,” Brown says. “Before Laserfiche, this was a laborious process that required manually entering statistics into a spreadsheet. Now, we use Laserfiche to pull this information directly from the ER log and store it in the document template fields. Our reporting server queries this information and automatically generates and sends the report—with no user interaction required.”

In the future, MDS plans to completely eliminate paper from their billing processes. “We’re in the beginning stages of adding additional automation and integration with our billing management system that will eliminate manual demographic and charge entry. We also plan to implement a paperless workflow in our payment processing department,” Brown says. “We are constantly looking for new ways to extend our Laserfiche system with integration and customization—so we definitely appreciate the ability to purchase components separately and add new ones over time.”

Customizing MDS’s Laserfiche system comes easy to Brown, who values the flexibility of Laserfiche’s open architecture. “As a programmer, I appreciate the expansive features of the Integrator’s Toolkit™,” he says. “With the Toolkit, you can create additional functionality with just a little effort. I also enjoy interacting directly with Laserfiche Developers through the Laserfiche Institute Conference, the Support Site and the forums.”

Brown doesn’t hesitate in recommending Laserfiche to his peers. “I would unequivocally recommend it,” he says. “After years of evaluating just about every document management system there is—and there are a lot—none of them comes close to matching the breadth of features Laserfiche provides.

“Along with our medical billing system, Laserfiche is one of our core applications,” he continues. “We would be hard-pressed to function without it. Employees benefit from rapid access to the information they need to do their jobs, and management benefits from the peace of mind of knowing the documents that are integral to our operation are safe and secure. It’s a win all around.”

The effort of managing paper meant the hospital wasn’t making effective use of its 1700-member staff. Using Laserfiche®, Iredell succeeded not only in cutting revenue loss in the ER and improving its patient record management, but it also greatly improved the efficiency of its own staff and the physicians the hospital works with.

The Situation

With as many as 300 ER visits on a single weekend night, lost and misplaced records forced the hospital to write off about $40,000 per month, with no way to properly code and bill for the visits. To solve the problem, management looked at a number of products over several months. After viewing several presentations, Iredell chose Laserfiche.

The Solution

“Laserfiche gave us what we needed and it was very user-friendly,” says Medical Records Director Marsha Hunter. “And we could develop the different templates and have a direct interface with the Keane Patient Management System®, which runs our patient accounting system. We manage patient charts electronically instead of on paper. The interfaces were easily written using the HL7 protocol and created index fields that allow authorized staff throughout the hospital to quickly search for any records”

The ER staff scans the records into Laserfiche, which reads the bar code and pulls relevant patient information and date of service from the Keane application. Staff no longer needs to manually input the data so labor time greatly reduced. Quick access to patient information from anywhere in the hospital is an added benefit.

Up and running in two weeks

“At the end of just two weeks we had scanned all the records from the previous month,” notes Hunter. “We had a fully functional system and the coders were coding remotely. Getting this kind of technology solution in place normally takes months.” Lambert worked with two members from Iredell’s HIS department to install the product and develop the integration with Keane.

Training was equally seamless, recalls Hunter, who wrote the policies to guide use of the system. “We had a lot of people to train and the ER is 24/7. We had to make sure all the clerks understood the processes and how to get records into the system according to the policies.” Each training session, first for 15 ER staff and then for 10 file room staff in medical records, took about a half hour “and they were very comfortable with the system.”

Seamless storage and retrieval without paper

Switching to Laserfiche produced dramatic results in streamlining workflow and hospital processes. Previously, the records system had been 100 percent paper, with the average ER chart composed of about 15 pages. In addition, the ER reception clerk routinely made and distributed four copies, one for hospital billing, one for physician billing, one for the quality department and one for the nursing staff.

Now the ER staff scans in records after the patient leaves, and anyone who needs to can view them-even simultaneously. “We’ve reduced paper in the copying process by 80 percent,” says Ron Gobble, Emergency Room Coordinator. “We scan all through the day, which is great. If there’s a patient that left two hours ago and calls back, all that information is already in Laserfiche and the nurse can just pull it up and look at it. We’re very pleased on our end.”

Using Laserfiche means that staff no longer has to track down a physical chart-they can access all the records in the Laserfiche repository. “Now we can give access to anyone who needs it,” says Gobble. “We don’t have to wait for the chart to pass around.” Most importantly, once a clerk scans in a record it can’t be lost. “We haven’t lost a single record,” says Hunter.

But the ER uses Laserfiche for more than charts. Staff scans in prior years’ correspondence and old memos, so they don’t have to physically store them. “It’s great to get them out of the office,” says Gobble. “If you need it, you can just pull it up-you don’t need to go searching through a bunch of files.”

Remote access and distribution

Hunter also appreciates the increased space Laserfiche has brought to the hospital through remote access and elimination of physical storage space. “In health care, real estate is probably the most expensive thing we have. So if I can free up office space or move my employees home, we’re thrilled.”

Laserfiche has greatly improved access to patient records by off-site physicians as well, allowing staff to email records to the doctors. “It really helps with our physicians group that’s in a town nearby. Before, we’d have to send them a record by courier. Now we can just encrypt it and send it right out-it really saves us a lot of time here, and frees up some of our personnel for other duties.” It also saves the physicians a good deal of money on courier fees.

Gobble also sees a vast improvement in handling physicians’ addenda, when they’ve missed something on their physician’s order sheets. “We can highlight it using the annotation functionality, fax it to them and they can send it back and it’s done. We used to have to get the physical record to the department when the physician was here. Now they make their changes and we just rescan it in.” Eventually, Gobble hopes to make the Laserfiche fax feature available, so staff can automatically fax records to doctors from within the application.

Beyond the ER

According to Hunter, “As soon as we went live with the ER system, the outpatient laboratory came on board. They were getting orders and requests and didn’t have a way to store them except for manual file folders-we couldn’t review them when we were coding the lab records. Now we scan all outpatient lab requests so we can code more effectively.”

Hunter has strong praise for Laserfiche. “We were able to accomplish everything we wanted to and more. Our physicians are able to get the records the next day. We have a program that automatically emails the charts over from the day before and it’s been a wonderful elimination of work for them and for us. They’ve been able to do their billing much more quickly.”

Today, the hospital uses Laserfiche in its rehabilitation center, cancer center, radiation therapy center, medical records department, quality department and in administration. To further improve communications and workflow, the hospital is about to integrate Laserfiche with its own physician’s Web portal. Doctors will soon be able to review not only ER records, but documents such as stop-med orders.

Hunter anticipates using Laserfiche for Microsoft® Word and Adobe® PDF documents and directly link to SoftMed®, Iredell’s dictation transcription product, so that eventually staff will need to scan only handwritten documents. And as Iredell continues to explore electronic document management, Hunter looks forward to using Laserfiche as the cornerstone of an electronic medical records (EMR) system. “I want to make Laserfiche the document management system for the entire hospital,” she says.

Compliance

Like any medical facility, Iredell faces a host of regulatory and auditing issues when dealing with patients, their safety and their records. Laserfiche has not only helped with business process management, but also eased security and record integrity compliance for the JCAHO-certified hospital.

“We’re able to set security levels for each department. We can control access to the system, chart, and document level. We are able to run audits on what records are accessed, view any problems and make sure records aren’t being printed out by people who shouldn’t have access to them,” says Hunter. “The security levels are great because we give a lot of people read-only access and that helps us know that records are secure.”

Hunter notes that Laserfiche helps Iredell with disaster preparedness, enabling the hospital to securely store its records with a completely redundant system offsite. “If one system goes down, we can easily do a complete recovery.”

According to Hunter, Iredell Memorial relies on Laserfiche to “make records available in electronic format, streamline functionality and save money on the back end by not losing revenues to misplaced records. The very act of moving from paper to electronic records is one of the best practices we’ve implemented.”

High paper pressure clogs medical biller

Hospital emergency rooms (ERs) are extremely busy and generate a flood of paperwork – including medical charts, insurance information and demographic data (address, employer, etc.). Marina Medical Billing Service provides emergency room billing services for a number of hospitals and emergency room physicians. The California-based company needed a document-management system to quell the rising mounds of paper. “We were entering and filing and archiving too much cumbersome paper,” explains Senior Director of Information Systems Lisa Busch, Marina Medical. “Some of the ERs we work with were already going paperless. That meant we were buying more printers and using more paper, toner and energy to print out the incoming electronic data. We were converting electronic records to paper! At the same time, we were growing; we needed room for people, not for paper.” Based on their research of paperless solutions, Marina Medical determined that the Laserfiche document imaging and management system was a good fit for their requirements. “Our billing software company, CPU Medical Management Systems, had worked successfully with Laserfiche in the past,” says Busch, “so we knew the Laserfiche system would work with our billing software. Marina signed a deal with Laserfiche for a 90-day pilot project, which was successful. Laserfiche reseller JPI Data Resource understands the health care business, and they made the pilot successful.

HP/Laserfiche solution passes the “stress test”

Before they committed to go paperless at all the hospitals they work with, Marina needed to “stress test” the Laserfiche solution to determine if it could still do the job three years down the road, when Marina expects to have more hospitals using it. Marina put together a test team of HP, Laserfiche, JPI and Integrated Solutions Group (ISG), an HP systems integrator. JPI and ISG strongly recommended HP hardware as the underlying infrastructure for the document imaging and management system, and Marina had good experience with HP products. Says Busch, “We always liked HP’s reputation for hardware reliability and service support.” “Setting up and running the stress test turned out to be a huge project,” says Dan Lundy of JPI. “HP Services did a great job of expediting the hardware and pulling it all together.”

The trial simulated 60 million pages of records, load levels at double the projected peak, and 200 users logged on simultaneously performing continuous search requests. The team also tested redundancy and failover capability in case of a power failure or system outage. The HP/Laserfiche environment passed every assessment. Says Busch, “We suddenly pulled the plug on one HP server, and in less than five minutes it failed over to the other system – with nothing lost and no hiccups. We were very impressed with Laserfiche and with HP technologies and the support we got from HP, JPI and ISG.”

Clean bill of health since going live

The test platform included the Laserfiche and VMware virtualization and failover software running on two HP ProLiant DL380 servers, with SQL database software running on a third DL380. An HP StorageWorks 1500 Modular Smart Array (MSA1500) provided storage. Based on performance in the stress test, Marina chose to go into production with the same software and HP hardware platform.

The MSA1500 provides economical shared storage and, with redundant controllers and switches, the high availability that Marina requires. The ProLiant DL380 G5 servers perform up to Marina’s high expectations, says Busch: “We have had no hardware-related issues since our go-live date. One of the noticeable immediate benefits of the HP hardware platform is that the modular design of the hardware components, particularly the MSA1500, and the compact, all-inclusive rack assembly help us take advantage of our limited server room space.” The Integrated Lights Out (iLO) management functionality of the DL380 servers enables remote management – without requiring a keyboard or monitor.

Increasing vitality by going paperless

The conversion to a paperless workplace must remain a very systematic process. While Marina’s clients are ER physicians and medical practices, the processes and systems they work with are based on each hospital’s own individual medical-record system.

With the HP/Laserfiche solution in place, Marina started going paperless one hospital at a time. “Electronic files from the hospitals are tricky to work with, because they are all different,” explains Busch. “When we take a new hospital paperless, we first map their data into our formats and figure out how to modify their data and get it into Laserfiche.”

When data comes in to Marina, it goes to the Laserfiche system, which captures the data, creates patient registration sheet and sends it to the CPU Medical billing system, which then generates patientbills. As the paperless system grows at Marina, it will handle an enormous amount of information.

“On an average, a hospital sees 3,000 ER patients per month,” says Busch, “and generates six pages of documents per patient. When 100 hospitals go paperless, we will handle almost 2 million pages of

documents each month.” Busch expects that it will take about 18 months to convert all of the hospitals they work with to paperless.

Building a healthy corporate lifestyle and boosting higher availability

Going paperless is also a major factor in helping Marina Medical Billing become a “greener”, more energy-efficient company – reducing its consumption of natural resources while controlling costs. Eliminating the need to ship tons of paper documents to and from hospitals reduces both shipping costs and energy consumption. Enabling staff to work at home reduces energy used in commuting. More directly, eliminating printing of documents slashes the number of printers Marina needs, and cuts significantly the consumption of paper, toner and energy.

The automatic failover capability demonstrated so dramatically in the stress test is an important feature of the paperless system. In a paper world, if the power goes out people could still pull files and keep the process moving. In a digital world, Marina must be able to recover quickly from a power outage or other failure. The Laserfiche software runs on two HP ProLiant DL380 servers with VMware High Availability functionality. If a server fails for any reason, the system automatically fails over to the second server and reallocates resources.

To support their ability to recover quickly from any sort of data loss, Marina added an HP torageWorks Ultrium 960 tape drive, LTO-3 Ultrium data cartridges and HP StorageWorks Data Protector Express software for data backups and restores. “The data on the tapes is just as critical as the data on the hard drives,” says Busch. “Using HP LTO-3 Ultrium tape media in conjunction with the StorageWorks Ultrium 960 tape drive promotes compatibility and reliability.”

Faster invoicing for clients, lower cost for Marina Medical

For their customers, the paperless system makes Marina more efficient and speeds up billing. As a result, revenue comes in sooner. In addition, all electronic document management makes compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations far more efficient.

Marina more efficient and speeds up billing. As a result, revenue comes in sooner. In addition, all electronic document management makes compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations far more efficient.

For Marina, the big payoff is eliminating the costs associated with handling and storing a huge amount of paper. Previously, Marina had 30,000 square feet of space at $26 per square foot. About 20 percent of the space was dedicated to storing paper, and that was enough space for only six months worth of paper. After six months, the staff archived the “old” paper offsite or in a less expensive part of the building. The paperless system reduces people costs as well as space costs. Some Marina employees spent all day swapping in new paper documents and taking out old ones. As hospitals go paperless, Marina takes people from phased out departments and retrains them for new work, which reduces hiring and training costs for new positions. The paperless, all-electronic system also lets people work off site, giving Marina greater staffing flexibility.

Going paperless also helps Marina grow its business. “Now we can grow without adding people,” says Busch. “And we can operate worldwide. Geography and distance are not a problem because we no longer need to ship tons of paper documents.”

“We’ve hit a mother lode for productivity increases,” reports Bonnie Kelly, FCI’s IT supervisor and the overseer of their digital document management deployments. “The initial projects are succeeding to the point where you feel compelled to find more uses for this technology.”

The original initiative for FCI was to convert the processing of insurance company explanation of benefit (EOB) reports from paper to a digital system based on Laserfiche document management software. The new system is now fully implemented in the ten FCI clinics and two in-vitro fertilization (IVF) centers located in Chicago its suburbs.

As the EOB project proved itself, Ms. Kelly and FCI management decided to take on the more sensitive challenge of asking the medical staff to move away from using paper-based patient charts. A pilot project went live in late May at the FCI clinic in Glenview, which is in the same building as FCI’s administrative offices and IT department. That project is going so well that virtually every one of the other locations is clamoring to be next.

“It’s all about ease of use,” Ms. Kelly says. “In busy medical environments like ours, you want to feel certain that everyone, especially the patients, is going to be comfortable with the change before you bring in a new technology.

“When we switched from paper to Laserfiche for EOBs in May, the patient account representatives were working with it like veterans by the end of the first day. Over the next several weeks, we saw so much improvement and so few problems that we felt confident that we could move on to the patient charts.”

FCI had local and national goals in mind for the conversion to paperless patient charts from the start.

Within FCI, the immediate objective was to give their physicians instant access to patient charts from anywhere, including when traveling from clinic to clinic to see patients and when out of town. Other expected benefits included (1) Being able to get rid of millions of pages of paper and the accompanying storage needs; (2) Virtually eliminating the potential that charts would get lost; and (3) Establishing a secure, Web-based document repository that would make it easier to comply with HIPAA and other regulations.

More broadly, FCI looked at digitizing their patient charts as a way to get more value from their custom-built ARTworks™ EMR (Electronic Medical Records) system created by IntegraMed® America, Inc., (NASDAQ: INMD) a national network of fertility centers in nearly 90 locations served by reproductive endocrinology specialists and PhD-level scientists. The Laserfiche solution complements the EMR system by giving its users instant electronic access to important, externally-created records and images. Moreover, FCI was aware that their success with a Laserfiche-based solution could establish standards that motivated the rest of the network to move away from paper-based document management.

“The clinics that have a lot of dealings with insurance companies want to adopt our way of handling EOBs,” says Ms. Kelly. “Just about everyone, however, right up to senior management at IntegraMed, is interested in using us as a model for moving to digital patient charts. They are very impressed with how easy it has been for us to take this step.”

If IntegraMed America decides to convert the entire network to digital document management, it will be the culmination of a thorough search for the right system for their needs.

“We have been using the ARTworks EMR for three years and recognized the importance of transitioning to a totally paperless environment,” says Ms. Kelly. “Once a practice moves to an electronic patient record, clinicians quickly realize the need to have all information accessible from the EMR, any time, any place. The Laserfiche solution provides secure and easy access to patient health information, supporting data-driven clinical decisions.”

Ms. Kelly says that she felt that Laserfiche was going to be the right digital document management solution for FCI by the time the Laserfiche reseller, Jerry Breitbarth of TKB Associates in Westmont, IL, finished his initial presentation.

“He was very familiar with EOBs and EMR systems and had handled a number of similar situations,” she says. “Plus, it was proven software that stood out for being easy to use. As part of that, Laserfiche had totally open architecture, which was essential to us because of our interest in being able to integrate it with other applications.”

Hand in hand with that thinking, an integration of ARTworks EMR and Laserfiche is currently in progress and is expected to go live at FCI soon.
About Fertility Centers of Illinois

Fertility Centers of Illinois, S.C., is one of the nation’s leading infertility treatment practices, providing advanced reproductive endocrinology services in the Chicago area for over 25 years. FCI performs more IVF than the next nine clinics combined, conducting more than 2,500 cycles per year. FCI has more babies born than the next ten centers combined with high success rates that are recognized throughout the nation. In addition to a team of nationally recognized reproductive physicians who collaborate with each other to stay current on the latest technology and procedures, FCI patients have access to many other unique support services such as professional counseling from a licensed, Ph.D. clinical psychologist, patient advocates and innovative financial options. FCI’s multiple offices are conveniently located throughout the Chicago area.
About IntegraMed America, Inc.

IntegraMed America, Inc. provides business services to a national network of 30 fertility centers in nearly 90 locations across the United States; distributes pharmaceutical products and treatment financing programs directly to consumers; and operates the Web site www.integramed.com, a leading fertility portal. The IntegraMed network includes 160 physicians and Ph.D. scientists. Network membership is limited to one practice per metropolitan area, yet one of every five IVF procedures in the U.S. is performed in an IntegraMed practice, bringing over 5,000 babies into the world yearly. IntegraMed provides more services to both consumers and medical providers in the fertility field than any other consortium.

Sun Health chose Laserfiche because it was a simple way to digitize their billing processes. The interface was very intuitive, and employees quickly began using Laserfiche to perform daily tasks, such as searching for outstanding bills. The patient accounts department now tracks patients from the time they are admitted. Each patient gets a unique bar code, and, once processed, all patient information is instantly categorized. The bar code is then added to every document pertaining to the patient’s care.

As the word of Laserfiche’s easy integration travelled throughout Sun Health’s two hospitals, the new system was incorporated into active care. Advance directives used to be filed with patient charts upon admittance. This meant that if a nurse needed to refer to the directive during a critical moment, she would have to find the chart. Using Laserfiche, Sun Health now automatically adds advance directives to patients’ digital folders. Nurses can access the Internet from any network computer, login to Sun Health’s secure document repository, and instantly bring up the patient’s advance directive.

Previously, Sun Health required a full-time staffer to scan all patient charts upon discharge. This process was ineffective because the charts were not needed so much after the discharge as during the hospital stay. Now, patients have electronic files with up-to-the-minute care data, accessible to hospital staff throughout their stay. Not only can nurses access patient information from any workstation, but the full-time staffer is able to do something more productive than scanning the charts of recently-discharged patients. Now, when patients are discharged, their full file is already in the repository.

Human Resources also uses Laserfiche to keep employees updated with critical policy changes. They scan all HIPAA Privacy Notices and MediCare newsletters. As laws change and adjust frequently, Sun Health has a way to keep on top of the changes.

“Laserfiche has been handling EOBs (Explanation of Benefit forms) practically from the first day. The staff literally can’t believe how fast they’re finding patient information.

“One of St. Luke’s most interesting applications so far is in marketing, where one of the primary tasks is to put together visual presentations of their work, sometimes as a way to prepare patients for their surgeries.

“They’ve already scanned in thousands of photos. With the simple template that we built for them, they are able to find the shots they need in seconds. It used to take hours.

“With Laserfiche, they’re going to be using a similar template to archive video clips of actual procedures. It will make it practical for them to start producing full motion video presentations as part of their regular routine. The long-term potential is awesome.”

MBC Systems uses Laserfiche software and utilities to process 8,000 pages of billing records per day. Employees electronically route documents between four different departments (billing, payment/processing, collections and clerical), tremendously speeding up the billing process and serving clients faster. They use Laserfiche’s capture tool, Quick Fields, to ensure accuracy as the clerical department takes in thousands of bills per day.

The company also utilizes Laserfiche software as a management tool. With Audit Trail, managers can run field entry reports describing employee productivity and efficiency. They can also track the number of bills that complete the processing cycle on a daily basis.

“Creating a digital workflow environment has revolutionized our medical collection efforts by empowering our staff with patient files that have total availability in disparate department desktops simultaneously,” says MBC Chief Information Officer Mardi Morillo. “The ability to send documents electronically allows us to work smarter while still applying healthcare processes and rules.”

“We congratulate MBC Systems on becoming a standard by which all healthcare organizations should measure their technology initiatives,” says Dennis DiMarzio of Ricoh Business Systems. “They saw the value of taking the time to extend the Laserfiche software to multiple departments, and their hard work is paying off everyday.”

Dr. Thomas M. Keane, a board certified oral surgeon and head of Keane Oral & Maxillofacial Surgery P.A. in Edina, MN, is already HIPAA compliant-with an assist from Laserfiche.

Keane had been hoping to get all of his patient records digitized for quite a while. The HIPAA deadline became the impetus to do it. “We’re trying to be a totally digital office,” Keane said.

The staff at Keane Oral and Maxillofacial Surgery scan all patient records, files and forms into a central database managed by Laserfiche where they are available instantly through a keyword or phrase search.

As soon as all the back files are scanned into the system, Keane plans to make patient charts accessible online from any room of his practice.

The measures enable Keane to be HIPAA compliant with room to spare. HIPAA fundamentally requires healthcare professionals who handle patient records and information digitally to have safeguards set up to keep those records safe from loss or unauthorized
access.

Larry Phelps of EDP Computer Systems, a Laserfiche Value Added Reseller based in Plymouth, MN, provides Dr. Keane with technical support and continuing advice on HIPAA compliance.

“We added Audit Trail to our Laserfiche system,” reports the hospital’s plant operations manager, Dwaine Boothe. “We’d planned to add this module to ensure HIPAA compliance when we chose Laserfiche.

“We bought it in as soon as our repository of scanned medical records was large enough to start sharing files with other departments and medical professionals. With Audit Trail in place, we are confident that our records will be in compliance with HIPAA moving forward.”

At this point, Franklin Medical Center has scanned more than 250,000 pages of medical records into the Laserfiche repository, including all active files going back a year. Emergency room doctors now have the ability to refer to Laserfiche to review the medical records of incoming patients.

Boothe expects the hospital to soon have all its archives in Laserfiche as part of an intensive scanning program put together by his assistant, Judy Ogden. That program will enable them to remove the five portable storage buildings that currently house paper records and that were their chief reason for turning to Laserfiche in the first place.

“I’m a one person department servicing six very busy doctors,” Ms. Goodyear says. “Laserfiche enables me to handle my insurance paperwork in a few hours every week. It used to take me three days.”

Ms. Goodyear has already had a hand in convincing one other eye care practice in the area to convert to Laserfiche, and has prompted no fewer than seven other medical practices to ask her Laserfiche reseller, Jerry Breitbarth of Westmont, IL-based TKB Associates, for demonstrations.

In addition, Ms. Goodyear caused a sensation when she told of her experiences with Laserfiche at the Chicagoland Chapter of the Professional Association of Health Care Office Managers (PAHCOM). “When I told them how much time I was saving, they couldn’t believe their ears,” Ms. Goodyear says. “Some of them literally ran up to me afterwards to find out how they could get going.” Not surprisingly, she and PAHCOM invited Breitbarth to make a full presentation on Laserfiche at one of their meetings.

“I’m involved with my counterparts at other practices because I hope to learn things from them that will make my job easier and better,” Ms. Goodyear says by way of explaining her outspoken support for Laserfiche. “So when I have something to offer that I think will really help them, I’m not going to hesitate to let them know.”

“Laserfiche didn’t just meet my needs for a production system, it helped solve the big compliance problems we face,” Amir says. “It performed so well that I created a new division to sell and support it.”

Ashron has extensive experience installing and supporting Laserfiche software because its own use of the product is so prevalent. Multiple departments use Laserfiche to access financial documents and other materials.

Today, Laserfiche handles more than 500,000 documents per year, putting documents within easy reach and backing up all records for compliance and disaster recovery purposes.

Sean McElroy, Ashron’s Chief Information Officer, applies the software to everyday management concerns and has found that it stands up to strict record-keeping challenges. Ashron needs to consider HIPAA regulations, and they store all patient documents for seven years.

“Setting up a new user is straightforward, yet all HIPAA compliance issues can be satisfied,” McElroy says. “I know, as our needs warrant, we can derive further benefits using Laserfiche’s powerful automation and workflow capabilities.”

“Laserfiche software has impressed me with its flexibility and commitment to standards,” Amir says. “So many application programs are proprietary, and I know many horror stories regarding conversions. Another key was ease of use. The benefits received from our Laserfiche install were so great that I couldn’t help but invest to take advantage of this as a sales opportunity.”

A move to a larger office helped for only a couple of months. More file cabinets did not solve the space problem, and another move was out of the question. Accucode had 20 medical practices and the ability to handle more. They just needed a way to manage all of the paper.

After reviewing several document imaging solutions, Ms. Morgan determined that only Laserfiche provided a scalable, easy-to-use management tool with embedded security features vital to the medical billing industry. The need for comprehensive security was especially important for compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for handling healthcare information electronically.

“Doctors depend on us to watch what they’re doing with their billing and to make sure all claims are paid,” Morgan says. “We deal with thousands of documents every day. For every patient, we scan in an information sheet, a copy of their insurance cards and the charge slip. It all goes into the appropriate doctor file and categorical sub-file as soon as it is scanned in. The patient’s billing records are almost instantly secure and retrievable.”

Today, Accucode scans all documents into their Laserfiche repository and handles billing for 32 doctors. While the workload has grown, Accucode has saved “at least a half-time employee,” or at least $10,000 in payroll, since converting to Laserfiche, Morgan says.

The first had been about a year earlier. Doctors at Kaiser Permanente Medical Center in San Francisco saved him then, with cardiac catheterization and angiography: Carefully, they slid a thin, flexible tube, or catheter, through an incision in the patient’s thigh, up through the femoral artery toward the heart. With dye and X-rays, they located areas of fat and calcium that blocked off the heart’s blood supply. Then they sent small, tough, balloons through the same vascular tunnel, and, inflating them at just the right spots, relieved the obstructions.

But that was nearly a year ago and 1,000 miles away. Now the patient was having his second cardiac episode-often a killer-and there was no time for another catheterization. His present doctor had to find out at once what the earlier cardiologist had learned. He made one telephone call and within 10 minutes, had in his hand a detailed report, 10 to 20 pages long, of the earlier physician’s observations.

While this case is fictitious, it is typical of what happens about 280 times a month, according to Denise Dyer, office manager at the Kaiser Permanente cardiac catheterization lab, which has just installed Laserfiche, a sophisticated system of document imaging, retrieval and virtually instant relay of data, from San Francisco to anywhere in the world. It often takes place in a situation in which lost minutes can mean lost lives.

With the Laserfiche system, developed by Compulink Management Center, Inc., of Long Beach, California, and installed at Kaiser Permanente in San Francisco by Unified Solutions, of Santa Clara, printed documents such as the cardiologists’s report can be scanned into an optical disk and retrieved in seconds. The process begins with an operator running the paper through a scanner, at a speed of ten sheets per minute. The data, now on a NetWare server, is then indexed under the patient’s name, hospital-admission and lab case numbers and a brief description of the procedure, and written onto a 5 ¼” optical disk.

The optical disk is one of 32 nested in a “jukebox” roughly three feet by three feet by two feet-the size of a small typing desk. The jukebox has room for 50,000 patient records, the equivalent of about 500,000 sheets of paper. And once a patient’s records are stored, it only takes a minute for an operator to retrieve and fax the data anywhere.

“We service approximately 15 Kaiser Hospitals and Medical Centers in Northern California,” Ms. Dyer said. “We have patients coming from all over the Bay area, from 60 to 80 miles away, for tests. The last figure I heard was 2.4 million patients. Now physicians in the outlying areas, if they don’t have a report, they can have that information as soon as possible. Especially when a patient winds up on their doorstep at midnight. It’s a situation in which speed really can save lives.”