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.

Before then, IT Director Lewis Paskin recalls PBC’s paper-based processes becoming overly cumbersome as the company grew, while escalating costs were adversely affecting profitability. There were shipping costs to receive charts; clerical costs to collate charts; and labor costs to copy, sort, log and distribute charts for coding, data entry and accounts receivable. “Adding to the paper overload were insurance claims that resulted in inbound Explanation of Benefits [EOB], patient payments, receipts, checks and correspondence—all of which needed to be opened, logged, accounted for and dispensed with daily,” Paskin says. “There were also significant paper costs from producing coding sheets for charts, making multiple copies of EOBs and eventually the long term offsite storage costs, as well as the HIPAA concerns that come with having all this copied and ‘travelling’ paper.”

Paskin led an internal committee to assess PBC’s needs in an enterprise content management (ECM) solution and began to search around four key features:

• Security.
• Accessibility.
• Accountability.
• Simplicity of user interface.

“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,” Paskin explains. “But we also needed a solution that was cost-effective and scalable. Our immediate goal was to be able to store billing records electronically, but our long term goal was a completely paperless workflow.”

Finding an ECM solution that fit—and would keep on fitting

PBC’s search soon took them to Laserfiche, and specifically to Laserfiche reseller JPI Data Resource. Paskin, for one, was initially skeptical. “When they said Laserfiche could dynamically create folders and structures as well as automatically extract text from documents, I told them I’d be shocked if it could. But it did,” he laughs.

“The Laserfiche product fulfilled our requirements,” Paskin continues, “but it was how it did it—the fact that it was really simple but also very powerful in terms of processing information—that’s how we knew it made sense for us. We have some of the least technical and most technical people working with our information, sometimes in a similar capacity. So, seeing how a staff member could just drop a document in a scanner and how Quick Fields automatically pulls and files all the metadata, or how Workflow would mean our users wouldn’t have to leave their desks, this was functionality we’d see improvements with immediately.”

Working with JPI’s Joseph Gutierrez, Paskin and his PBC team designed a 20-user Laserfiche system including Audit Trail; Workflow and Quick Fields; Bar Code and Zone OCR; Scan Connect and Snapshot for capture; and set up five different scanning stations. Installation, Paskin notes, was completed in less than a day, while user training took less than three days.

Paskin credits the comprehensive capture methods with making the transition to an automated environment a smooth one. “We’ve found that working with whatever file format a hospital is using with minimal modification is our best way to retrieve data,” Paskin says. “We do a lot of scanning directly into Laserfiche from our hospital clients’ facilities, which makes for a wide differential in chart documents. Some hospitals send charts with barcodes, others use file names, some just send text, but through the various Laserfiche applications we ferret out a way to get the data into the system.”

The biggest improvement, he notes, has been in processing paper. “Staff now simply scan those documents, either separated by bar-coded index sheets or by utilizing Zone OCR, into Laserfiche. Quick Fields reads the patient’s name and ID from the bar codes and automatically indexes the scanned files and fills in all the necessary document metadata.”

The effect was as impressive as it was immediate. “We were able to migrate one of our largest volume clients to a completely paperless environment in less than a week. Then we started bringing our other client applications online,” Paskin says.

Scanning volume soon hit 50,000 pages a day. “We scanned over 200,000 documents containing over 2.5 million pages in just under one year,” he adds.

The process(es) of coding and billing, better and more efficiently

The impact on PBC’s business processes was transformative:

• Laserfiche Import Agent constantly monitors the multiple directories PBC has set up to receive files.
• Laserfiche Quick Fields then extracts and sorts data, which triggers Workflow to route files to the respective departments that need to touch the document before it moves forward and is finally archived.
• If any predefined criterion is missing, Workflow automatically reroutes the record to the appropriate department for further follow up.

Previously, PBC’s coders signed out up to three days’ worth of charts and held them at their desks until coding was completed. Charts were then passed in bulk to the insurance review department, then on to data entry for manual entry to initiate billing before eventually being archived in a file room and sent to an offsite storage facility. Now, PBC coders work and code offsite, accessing information over a secure connection to PBC’s terminal servers.

“An entire team of people no longer need to work in the office—everything’s accessed and managed centrally through Laserfiche,” adds Paskin. As the coders finish a chart, it automatically moves through the workflow to the next department, speeding up and evening out the process from inbound chart to billing.

“We have over 10 different client applications that reside in Laserfiche—five of which are hospital-related, and three that are used by our Accounts Receivable (AR) department to look up claim denials, track work batches and store EOBs. We’re using it in more than five distinct departments including coding, claims processing, AR, finance and Human Resources; it’s our document management back-end for all our lines of business,” Paskin says.

This centralized control has improved oversight to monitor productivity as well as to ensure HIPAA compliance. Using Audit Trail, a document ID number can trace the file’s history. “We can see who changed what—and when—for every document,” says Paskin.

Another benefit, Paskin adds, is the ability to use SAP Crystal Reports tools to help monitor PBC’s workflow. “We have about 15–20 reports that go out daily—one of which is referred to as our ‘bucket report.’ When we receive a medical chart, getting it coded and billed quickly is key to cash flow. The bucket reports tell us how many charts are sitting in a user’s folder. Because all this data is in a single, centralized repository, it’s easy to create reports,” says Paskin. “I credit Joe and JPI with understanding our business well enough to show us how we should have our information structured.”

Automating the billing process itself, Paskin notes, “works essentially the same way it does in the Laserfiche brochure that JPI showed us initially. Again, everything’s in a single and straightforward database. We simply wrote Java and Web-related scripts to pull the account number, CPT and diagnosis codes to automate the actual billing process. Of course, there was controlled testing for about two weeks before we went live, but that was it.”

Now, PBC’s business processes are synonymous with Laserfiche—and significantly improved. Paskin points to processing the hundreds of charts sent to PBC on any given day. “That used to take three employees a full day to process manually; now it takes one person about 15 minutes.

“Our original vision was a paperless workflow, and we’ve pretty much achieved that. We have over 800,000 documents representing 10 million pages, and that all happened within the past 2 ½ years,” he adds. “We have redeployed 60% of our FTE’s required to produce a claim, and no longer need a night shift to keep up with the workload. Considering how far we’ve come, it’s pretty amazing.”

For more information, read Laserfiche’s ECM for Third Party Medical Billing brochure.

Read more about PBC.

By 2007, CapitalCare’s decade of growth had the side effect of generating more paperwork than the group’s 14 offices could efficiently manage—at least not the way they had been. “We were on our fourth expansion in our central office building in Albany; our offices were running out of storage and our CBO had rooms of files and boxes everywhere. So we asked ourselves, ‘Why all this space for storage? Why all this time to find things?’” says Charles Hagstrand, CIO of CapitalCare. “After 10 years, we needed a solution to move us forward.”

Hagstrand envisioned a true enterprise content management (ECM) solution from the start, one that could manage CapitalCare’s spectrum of information needs, including 700,000 patient encounters a year being stored remotely to over 280,000 EOB documents generated annually, as well as other documents and business records associated with its various practices. Eventually shared back-office business processes would be automated, beginning with AP processing.

“Initially we looked at a lot of vendors who had products that handled specific document types, but we were looking for something that wouldn’t pigeonhole us,” recalls Hagstrand. “You see a lot of departmental applications in larger organizations. We wanted a single system that could fit a variety of needs in different departments, and that ultimately could grow with us.”Hagstrand found what CapitalCare was looking for when his evaluation team discovered Laserfiche through reseller JPI Data Resource. “It was the product’s versatility that really won us over,” he says. “We liked that Workflow was a push technology that could keep things moving more effectively.”

Adds Jason Wicks, business analyst, “Laserfiche was like one-stop shopping as far as addressing the range of projects we were looking at, from HR files to Accounting and through-processing contracts and invoices. It’s very flexible.”

Wicks worked with JPI and CapitalCare department heads to design and deploy a pilot 20-user Laserfiche system with Records Management Edition (RME) and Workflow. They mapped out a multi-phase implementation that would eventually include using RME to automate retention and compliance, as well as Workflow to route invoices from CapitalCare’s central business offices in Albany to the group’s various remote locations for AP processing.

The first order of business was addressing Hagstrand’s storage and access concerns. “We took the approach that we should start by working with the items that didn’t involve Workflow first,” Wicks says.

Implementation began with backlog conversion of a decade’s worth of historical files in the HR and Medical Management departments, “just taking paper and getting it in Laserfiche to get people used to archiving,” as Wicks puts it.

The impact was immediate. “Our first touch is our site managers who are working with our patient encounters—that totals over 700,000 documents a year,” Wicks explains. “We used to have to process those in our central business office, then send them back out to the sites to store for seven years. Now they’re all inputted when received from the site and accessed as needed through Laserfiche.”

Standardizing to streamline AP processing

The next phase of implementation deployed Workflow to help automate AP processing for CapitalCare’s accounting department—which has seen the number of sites it supports grow from 14 to 27 in the four years since Laserfiche was acquired in 2007.

“Before Laserfiche, AP processing wasn’t very efficient, nor was there a common practice for approving invoices,” Wicks explains. “Some bills were received at the site, approved and forwarded; others came to the CBO and were distributed for approval and return. Laserfiche allowed us to standardize the process, and that’s been a big time saver.”

Thanks to Laserfiche, turnaround time for AP processing was reduced from 7–10 days to 2–3:

• Invoices are now captured and sorted centrally using Quick Fields in CapitalCare’s Albany office.
• Workflow then automatically routes the invoices to the appropriate site managers, who are notified through email that they have a document to approve with a shortcut link to retrieve the document.
• Working in conjunction with a custom file export tool developed by JPI, approved documents are then automatically pushed from Laserfiche to CapitalCare’s Great Plains accounting system via QuickLinks and PaperSave.

“Accounting now knows what documents need approval and which documents are in a queue once the site has approved the document,” Wicks says. A backup copy of the exported document is created using Workflow, which, after 30 days, is automatically deleted by a Workflow activity.

The next phase, Wicks adds, will be to establish a centralized shared service center, where invoices will be processed directly from the central business office. “Workflow will set up queues for each of our sites’ accounting departments to process invoices,” he says.

An overall benefit, Wicks says, has come from the time saved making action items more available to site staff. “Although we have a separate solution to store patient medical information for continuity, middle management at each site—typically one or two employees—utilizes Laserfiche to access past patient encounters, approving invoices and coding corrections, and this has eliminated a lot of lag time.”

The future of the future: Workflow

Future projects are already slated—including implementing RME. “The functionality of Records Management Edition will assist with purging documents once they have reached their shelf life, while Audit Trail will help keep us in compliance,” Wicks says.

Hagstrand says even the IS Department has its own ideas for how to utilize the system. “We’re actually hoping to use Laserfiche to manage our service agreements, so we’ll be able to run queries and see what’s going to expire in the next year.”

“The system keeps evolving as we bring on more documents and processes,” add Wicks, pointing out that Workflow will play a more leading role in future deployment. “I’d say we’re at the grassroots of pushing information between sites and departments. Right now, I’m looking at any situation where we have an opportunity to push documents and how we can utilize Laserfiche to automate additional functions between our practices and our central business office,” he continues, noting a recent meeting with a business unit to discuss improving billing and coding through automation. “Workflow has really worked out for us because we can take the visual process of scanning documents and apply that to designing workflows—it’s very intuitive.”

This versatility, says Wicks, is why Laserfiche use continues to evolve. That, and Wicks makes sure CapitalCare’s 50 named users know just what’s possible using the system that solved their initial storage problems.

Says Wicks, “We need to do more education within the company to say ‘This is a lot more than just a scanning solution’ and hold a ‘Did you know?’ session.”

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.

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.”