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.”

For example, Spindletop Mental Health Mental Retardation (MHMR) Services has integrated Laserfiche with its Microsoft SharePoint portal to enable case management. According to Spindletop CIO Jerry Carnley, “With Laserfiche, there’s no more waiting around for days for hardcopy documents to be found, and no more lost or misfiled records resulting in huge institutional fines. And we aren’t spending upward of $2,000 each month on offsite storage facilities.”

Meanwhile, Molina Healthcare has decreased the turnaround time for credentialing by 44% while doubling number of applications processed per month through its use of Laserfiche. According to Ryan Boe, Corporate Credentialing Manager at Molina Healthcare, “With Laserfiche, 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.”

Agile ECM systems from Laserfiche allow healthcare organizations to store, locate, route, approve and review both paper and electronic content—including medical records, lab results, signed privacy acknowledgments, explanation of benefits (EOB) forms, invoices, purchase orders, personnel files, compliance records, referrals and more.

Additionally, Laserfiche provides comprehensive security that protects sensitive information while still allowing authorized personnel to instantly access necessary files—protecting the integrity of patient information and facilitating HIPAA compliance.

Detailed case studies outlining the success of Spindletop, Molina Healthcare and more are available at the Laserfiche booth (#4131). A comprehensive white paper outlining the benefits of agile ECM is also available to all HIMSS attendees.

About Laserfiche
Since 1987, Laserfiche® has used its Run Smarter® philosophy to create simple and elegant enterprise content management (ECM) solutions. More than 30,000 organizations worldwide use Laserfiche software to streamline document, records and business process management.

The Laserfiche ECM system allows healthcare organizations to securely manage patient records, accelerate payment cycles and decrease costs. It enables organizations to more easily comply with HIPAA privacy rules and Joint Commission patient safety goals—all while accelerating business processes and making staff more efficient.

Laserfiche is a registered trademark of Compulink Management Center, Inc.

Martin Lovelace-Chandler's Laserfiche workstation

Born with a form of cerebral palsy that limits his motor skills and speech, Lovelace-Chandler has embraced technology with a purpose and passion in his life and career—at least as much as the technology has been able to keep up with the ambitions of the now-married father of two. “In college [in the late ‘90s], I really wanted to go into computers but I didn’t have a way to type or to use a mouse,” he says. After Lovelace-Chandler became an ASN client a decade ago, Dr. Vire had a great idea: to make ASN’s client files accessible to staff by scanning cumbersome paper files to disc. “It was just costing the agency storage every month. He asked me if I could help. I told him I can do anything on a computer if he just gets me the right equipment,” Lovelace-Chandler remembers.

The “right equipment” has changed a lot over the years. Realizing it needed a network solution to make scanned information more easily accessible to staff, ASN implemented a Canofile imaging system in 2006, but quickly found it fell short of its promise. Lack of indexing and usability meant ASN’s 20-plus case managers were still using three-inch thick paper files—sometimes three or four of them per client—which were time-consuming to locate and use and even more resource-consuming when it came to storage and auditing. It was “nightmare-ish stuff,” as Dr. Vire remembers. The one bright spot was that Lovelace-Chandler started using a combination keyboard and mouse that allowed him to program hotkey shortcuts—“macros and micros,” he calls them—that cut the keystrokes required to open up programs like Canonfile from 10 to two. “This allowed me to spend more time on the program itself and gave me total independence,” he says.

Over time, just as Lovelace-Chandler upgraded his communication device to a simpler and more comprehensive “Eco 14” model, ASN likewise upgraded to Laserfiche in 2008. The reason was twofold: “We wanted to be able to have all current and past files on Laserfiche so then it would be at everyone in the agency’s fingertips,” Lovelace-Chandler says. “We also wanted a program that would have a higher security feature after the HIPAA law went into effect.”

Although Dr. Vire admits that system adoption initially took time—not everyone was as attuned to the benefits of using technology as Lovelace-Chandler—the impact has been real.

“There was a time when, if we had a question about an individual’s plan from last year, we had to send someone to a storage unit and hope they could find the correct file, and then hope that the information was in the correct place. We almost always found the document, but the time invested was huge. We can now find that document in minutes rather than hours—and we’ve never had a water leak that left our Laserfiche files water-logged and unusable,” he says. “Laserfiche is definitely a time and money saver.”

For Lovelace-Chandler, a key benefit is how easily he can set up and administer ASN’s Laserfiche system for the case managers who use it on a daily basis. In addition to processing the 200 or so documents generated in the field every day, Lovelace-Chandler has added indexes for medical history, case manager notes and program plans, among other documents. “I’m able to use drop down lists for 98% of the fields,” he says. “It allows documents to be located faster and more efficiently.” And, he adds, securely.

“Laserfiche allows me to give only the people that should be seeing a certain region access. So for example, a case manager might have several consumers out of several regions, but that case manager only has access to each consumer that they are assigned—it’s a lot easier to them to access, and I love that security is set up differently,” he explains. “On Canofile any person could look up any consumer and see all their files. Now, with Laserfiche, I can assign that consumer just to who actually needs access. We also set up groups for each department. For example, Human Resources can’t access supported living files and vice-versa. We really like this because we can track who all is accessing all the files.”

He particularly likes Laserfiche’s support for Window Active Directory. “Almost every day I use the multi-media function to add employee names to the list.”

Another area of improvement has been auditing. As a healthcare services provider with funding and oversight from state and national agencies including the Department of Health and Human Services (which monitors HIPAA compliance), the Arkansas Department of Human Services and the Division of Developmental Disabilities Services, ASN is subject to frequent audits—as many as four per year. “We had an agency that told us that we had so many days to find documents or our agency would be fined. I was able to look up and send them every document they wanted. I would have spent twice the amount of time looking for the documents if we were still using Canofile,” Lovelace-Chandler says.

In addition to using Laserfiche for case management, Lovelace-Chandler also uses it to manage payroll, HR and AP processing. The plan, says Kevin Dickinson of ASN’s Laserfiche reseller, Preferred Office Products, is to implement Quick Fields, possibly even equipping case managers with netbooks to directly input their notes, freeing up Lovelace-Chandler’s time.

“I feel that having Laserfiche we will be able to do bigger and better things in the future. I also feel that it will help us greatly since our agency continues to expand,” says Lovelace-Chandler.

“I have been able to use Laserfiche more than any other program. With the features of Laserfiche it is an easier process to program my device and to use all the features that the program offers. I feel like Laserfiche could open a lot of doors for me or even people like me that have a physical disability,” he adds.

Likewise, Cunningham saw that RHC’s case management system could be made more agile. For starters, RHC’s 90 employees needed to find a better way to fulfill the information requests from over 3,400 court officers requesting client information from the agency. A legacy imaging system allowed staff to scan and attach documents to client records, but without a comprehensive search tool to locate specific documents or the ability to search by keywords, requests required a staff member to find the document in the case file, download it and attach it. Even more laborious was inputting information. Court papers and probation documents would need to be faxed in, re-scanned and manually inputted. “It didn’t just waste time, it wasted paper,” Cunningham says.

The logistics of real-time case management over three states was also a challenge. “Like any multi-state, multi-location business, we need access to files and data anywhere we’re doing business,” Cunningham says.

In March, Jeff Flory of Laserfiche reseller Datamax of Texas introduced Cunningham and the RHC staff to Laserfiche enterprise content management (ECM). “The nature of RHC’s business is that it’s not only very paper intensive, but also very information dense,” Flory notes.

Flory showed RHC a Laserfiche Avante system with Workflow, Web Access and a WebLink public portal. Cunningham and his staff agreed Laserfiche was just what RHC’s case management system needed. For starters, Laserfiche’s full-text search and ability to locate individual documents within client folders would make case information that much easier to look up. But, Flory says, it was how Workflow would automate and simplify the capture process that convinced Cunningham of the real value of the Laserfiche solution.

“All a staff member has to do is fill out the template field using drop down lists and a couple of key fields, and then send the document. Workflow picks up the document, names it, and puts it in the right folder. For an organization like RHC, where many different users are scanning content themselves, this adds the assurance that all documents adhere to a consistent naming and foldering convention,” Flory says.

Cunningham was impressed. “I can have a staff member anywhere in Texas, in any court room, in any of 254 different counties, and all they need is a little road warrior scanner and a laptop. They can upload the court orders from wherever they are, and Workflow does the rest.”

Add to that the ability of Web Access to enable remote deployment and WebLink to allow the 3400 court officers requesting information to locate it themselves, and Laserfiche provides RHC with an ECM system agile enough to streamline its case management system.

Implementation is still ongoing, but already Cunningham is recognizing the long-term benefits. “Laserfiche will enable me to have a company-wide retention policy. We’re subject to audits by the IRS and the U.S. Department of Health and Human Services (who enforces HIPAA), as well as state regulatory authorities, and I can already foresee that first audit where we can pull up all the contract and court documents associated with the GPS and SCRAM system quickly and easily, right from Laserfiche. I’m going to be glad we have this. I look at it as corporate security.”

Next up, he says, RHC is looking at integrating its SCRAM system with Laserfiche to enable more active case management. “It’ll be just that one ID number and the user will have everything,” Cunningham says.

But even now, Cunningham adds, he’s satisfied. “I know I don’t want paper and Laserfiche helps me get rid of it,” he says. “I don’t want to have to spend a lot of time training anybody—I just want to be able to get my information when I need it, how I need it.”

• 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.”

As Renaissance staff explain, when an advisor is spending time searching through paperwork, that’s less time he or she has to focus on what the firm is known for: managing securities and investment plans, offering quality advisory services and helping with small business planning. “The more time advisors spend finding paperwork, the less time they have to spend building client relationships. We’re constantly trying to find ways to streamline processes so they don’t have to spend time doing administrative tasks.”

By implementing a Laserfiche enterprise content management system, Renaissance has easily helped its advisors to become more productive, by enabling advisors and staff to organize and manage account information and records quickly and securely. Before implementing Laserfiche, when a client wanted to modify their portfolio, an advisor would need to leave their desk, go downstairs to a storage room, locate the client’s paperwork, dig it out of the file cabinet, and then finally return to their desks to start making the necessary changes. Now, with Laserfiche, when a client calls, the advisor can immediately access account information and instantly satisfy information requests.

The result is a win-win: Renaissance’s advisors are more productive and clients are satisfied with faster, more comprehensive service.

Ease-of-Use Ensures 98% Success Rate

When Renaissance implemented Laserfiche ten years ago, the company only had 40 employees. Today, over 150 employees—including 100 advisors—use the system.

When Laserfiche was first implemented, the Team Services department held several large training classes in each of Renaissance’s three offices, as well as several one-on-one sessions, to get everybody comfortable with the system. Thanks to Laserfiche’s ease-of-use and Renaissance’s one-size-doesn’t-necessarily-fit-all training strategy, system adoption has been impressive.

Renaissance reports a 98% success rate with advisors switching from paper to Laserfiche. Some advisors still wanted their paper files, but staff believe that “Laserfiche is so easy to use that they’ve almost all adopted it. It’s a very user-friendly system.”

Laserfiche Lessens Compliance Risks

Renaissance’s move to Laserfiche made sense not only based on the time it took to work with paper, but also the compliance risks that came with it. The variety of services Renaissance provides led to competing compliance requirements with FINRA, SEC and Sarbanes-Oxley regulations, as well as HIPAA. And when advisors met with clients, any notes they wrote down the firm was required to keep. With 100 advisors, that added up to a lot of paperwork.

Other paper-based processes included:

• Stock trading, which required trader tickets to be captured and stored on a daily basis.
• The new application process, which involved multiple forms.
• Internal employee documentation, including FINRA and SEC licensing files.
• Compliance department documents, including internal examinations.
• Quarterly investment reviews, including reports and advisors’ notes.

Since implementing Laserfiche, Audit Trail provides an extra layer of security. With Audit Trail, administrators easily track any modification of data stored in the Laserfiche repository, watermark sensitive documents and log any unsuccessful attempts to perform an action on a document. Audit Trail Reporter then filters, sorts and graphs audited data via a Web-based Audit Trail page which can be saved for later retrieval or sharing with others. Thanks to Laserfiche, audits that used to take days now take hours.

Staying Ahead of the Game

Based on the time and resource savings of Laserfiche, Renaissance staff believe it’s not a question of “if” other firms follow Renaissance’s lead, but “when.”

“We’re here to get in the game and stay a step ahead. The whole concept of streamlining your workflow and having your information centralized is the future of financial services.”

“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.”

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.”

“The philosophy behind many of our technology initiatives,” he explains, “is to present information on the Web, rather than face-to-face. Not only is it a whole lot less expensive, but it’s so much more convenient for citizens.”

Before implementing Laserfiche, completing everyday tasks was far from convenient. Jackson describes the working environment as “Paper, and lots of it. Our business processes were mostly manual and very costly, with regard to both lost productivity and excess paper consumption.”

Gaston County had another document management system in place when Jackson arrived, but it didn’t meet all of the organization’s business needs. “Our previous software lacked Web publishing and OCR capabilities,” he recalls, “and its architecture couldn’t scale to support our more ambitious initiatives or additional departments.”

Keeping in mind both present needs and future plans, Jackson authored an RFP, to which seven vendors responded. While two other solutions provided similar functionality to Laserfiche, none could match its cost-effectiveness. “Return on investment was probably our chief criterion,” he says. “Laserfiche offered the quickest ROI of all the potential solutions.”

It offered fast deployment as well. Within 6 weeks, the environmental health department had scanned paper records of over 55,000 septic system inspections dating back to 1955. Jackson gives much of the credit for Gaston County’s success to its Laserfiche reseller, One Source Document Solutions. “Our reseller has been great to work with, and they’re a great representative for Laserfiche as well,” he says.

The HR, finance and building inspection departments were also part of the pilot installation. “It was really a ‘first come, first served’ process,” Jackson says. “These departments really wanted to be the initial adopters of the new technology.”

In addition to these departmental champions, Laserfiche also found strong political support. Gaston County commissioners had recently passed a resolution enabling deployment of new e-government initiatives—many of which fell right into Laserfiche’s wheelhouse. “Our commissioners are very interested in using technology to reduce costs, so fortunately, we didn’t have major problems getting funding for our Laserfiche system,” Jackson says.

Deploying at the departmental level proved advantageous in convincing decision makers that Laserfiche would support their goals. “It allowed us to present concrete cost savings to commissioners,” Jackson recalls, “so they’d be on board with expanding the system. It also helped us persuade the few skeptical staff members that, when all is said and done, Laserfiche would make everyone’s jobs easier.”

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It turned out that staff didn’t need much persuading at all. “The resistance to change has been far less than for other applications or new business processes,” he adds. “Employees all realize how tedious working with paper is, and that the opportunity to digitize will help them tremendously.”

Indeed, after just one year of using Laserfiche, staff and citizens have already realized many benefits. For example, Laserfiche Records Management Edition™ (RME) has greatly simplified the way staff work with records series. “It’s very easy to establish new records series in RME,” Jackson says, “and when it comes to managing them, staff simply scan documents in and let the system worry about the rest.”

Beyond sophisticated behind-the-scenes records management, staff greatly benefit from one of the most basic Laserfiche functions. “Laserfiche gives staff the ability to search in so many different ways,” Jackson notes. “For research and information requests, it’s really reduced the amount of information staff need to find what they’re looking for.”

In a recent case study, the building inspections department documented just how much more efficient they’ve become thanks to Laserfiche searching. With 6,000 building permits filed yearly, staff spent an estimated five hours per day filing and handling research calls. Because they can now index and retrieve documents automatically with Laserfiche, they’ve reduced the time spent answering those calls by 75%—saving almost half a man-year of work.

And that’s just in a single department. “We know that once we start deploying to larger departments, the savings will mount up into the millions of dollars,” Jackson says.

From an IT perspective, Laserfiche offers many advantages to Jackson and his staff. First and foremost among these is ease of administration. “We’re a Windows®-based shop, so we really appreciate the way Laserfiche integrates with Active Directory®. That made it really easy to fit Laserfiche into our operating environment.”

Because deployment was so smooth, Laserfiche delivered quickly on its promises. “Many solutions have the potential to increase productivity or lower costs,” he adds, “but are very difficult to set up. With Laserfiche, the upfront investment to attain these kinds of benefits is very low.”

With such rapid results, it wasn’t long before other departments were lining up to request their own Laserfiche systems—a common occurrence among new Laserfiche users. “Once other departments saw the benefits that the pilot departments were reaping, they came to IT and said ‘sign us up,’” Jackson remembers.

In response to these departmental demands, the 2008 Gaston County IT strategic plan includes a major expansion of their Laserfiche system. Planned enhancements include integrating Laserfiche with their redesigned GIS system, so that staff and citizens can retrieve parcel information and tax histories. The emergency medical services department will begin storing patient records and ambulance call histories within Laserfiche—which will help answer HIPAA compliance challenges. Meanwhile, the county attorney’s office will use the Workflow™ module to simplify the contract review process by automatically routing contracts for approval.

Workflow will also play a major role in some very sophisticated e-government applications. “We’re developing Web forms that will send information straight to Workflow,” Jackson says. “For example, employment applications submitted online will go straight to HR for initial screening, then on to hiring departments, who will route back the applications of individuals they want to interview or extend offers to.” Similar technology will enable citizens to submit permit applications and pay taxes online as well. And the building inspection department, one of the earliest adopters of Laserfiche, has become the first county department to go paperless, after receiving state approval for self-warranty in May 2008.

Internal business process improvements notwithstanding, the number-one goal of implementing Laserfiche was to improve citizen service. The citizens’ response? “They love it,” Jackson says. “Having building inspection reports online has been a major success. They can’t believe how much time they save. Previously, they had to call us, come into the office or travel to an inspection site. Now, they have on-demand access to all that information.”

Not bad for the first year. But Jackson is gearing up for bigger and better things. “I knew that digital document management would be a major asset, not only in the short term, but also further on down the road. I really anticipate that, within five years, Laserfiche will become as widely-used as e-mail.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

High paper pressure clogs medical biller

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

HP/Laserfiche solution passes the “stress test”

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

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

Clean bill of health since going live

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

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

Increasing vitality by going paperless

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

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

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

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

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

Building a healthy corporate lifestyle and boosting higher availability

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

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

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

Faster invoicing for clients, lower cost for Marina Medical

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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