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.”

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.”

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.”

“Practicing medicine is complex enough without software making things more difficult,” said Laserfiche Senior Vice President Chris Wacker. “There are many complicated EMR solutions out there that create more stress for doctors and practice managers, and our natural ‘hybrid’ approach to EMR alleviates that.”

Laserfiche will demonstrate how its simpler, more natural approach to EMR—built on a content management platform—has enabled many practices to scan and store electronic patient records, improve billing processes and reap an impressive ROI (booth #1243). For example, Children’s Respiratory and Critical Care Specialists in Minneapolis, MN, uses its Laserfiche system to handle traditional EMR applications like patient charts and data mining.

“It has served us really well and it didn’t require a total revamping of our internal processes,” said Children’s office IT manager John Stamm. “There are no lost charts, but the biggest plus has been easy access to those documents by multiple people from various locations. Doctors, front office, billing and nursing can all access the same chart at the same time. This is especially important when you have multiple sites.”

He concluded, “Doctors don’t typically like EMR systems because they require major changes in clinical workflow; a content management system does not.”

About Laserfiche

Laserfiche® creates simple and elegant content management solutions that help organizations run smarter. Since 1987, more than 27,000 organizations worldwide—including healthcare organizations, government agencies and Fortune 1000 companies—have used Laserfiche software to streamline document, records and business process management.

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