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.”

“Many providers adopted EHRs thinking that these systems would make their practices paper-free,” said Laserfiche Vice President Tom Wayman. “In reality, there’s still a lot of unstructured content that needs to be managed in a HIPAA-compliant fashion, including consent forms, EKGs, EOBs, physician licenses and more. ECM is the key to completing your transition to a secure, efficient and paper-free practice.”

Laserfiche solves business problems across the practice, facilitating everything from patient records management to HR onboarding and disaster recovery planning. “Laserfiche is committed to providing stress-free ECM solutions that are easy to implement, easy to administer and easy to use,” said Wayman. “As such, we’re offering free massages for MGMA attendees to reflect our commitment to making life easier for practice managers and physicians alike.”

Laserfiche will be on hand at booth #1245 throughout the event to demonstrate its software solutions, provide free massages and distribute copies of customer success stories featuring Fertility Centers of Illinois, Dallas Associated Dermatologists and Arkansas’ CareLink.

About Laserfiche
Since 1987, Laserfiche® has used its Run Smarter® philosophy to create simple and elegant enterprise content management (ECM) solutions. Since 1987, medical groups have used Laserfiche to manage both patient and practice files in a HIPAA-compliant environment, easily increasing information access, speeding billing processes and saving time and money.

Laserfiche®, Run Smarter® and Compulink® are registered trademarks of Compulink Management Center, Inc.

• Medical Billing: Pre Billing Consultants
• Accounts Payable: Indigo North Health
• Land Records Management: Bremer County, IA
• RIA Compliance: Level Four Group

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

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

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

“We needed to make sure that billing records were easily retrievable, that protected health information was secure and that we could account for all our documents,” Paskin explains. “But we also needed a solution that was cost-effective and scalable. Our immediate goal was to be able to store billing records electronically, but our long term goal was a completely paperless workflow.”

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

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

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

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

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

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

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

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

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

The impact on PBC’s business processes was transformative:

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

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

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

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

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

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

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

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

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

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

Read more about PBC.

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

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

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

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

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

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

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

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

Standardizing to streamline AP processing

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

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

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

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

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

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

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

The future of the future: Workflow

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

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

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

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

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

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

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

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

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

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

Leveraging Laserfiche

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

Here are a few of the benefits Laserfiche provides:

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

Results

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

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

According to McDonough, PPS’ IT Director became interested in Workflow after Duplitron created electronic lockboxes to batch claims documents using Quick Fields last year. “That brought us one step closer to automating the whole process,” he explains.

Actual Workflow implementation took place earlier this year as part of an upgrade to Laserfiche 8. “There were a lot of what I’d call ‘curveballs,’” says McDonough. “For instance, when we created the lockboxes, we split up the documents to be processed in Quick Fields based on their FSC coding, but that one lockbox had to remain intact—the documents could move but the folder couldn’t.”

Working with Laserfiche Presales Engineer Jonathon Kim as well as VAR Desk’s Lisa Durham and Jessica Smith, Duplitron configured Quick Fields and Workflow to fit the intricacies of PPS’s claims process—with significant results. “It use to take a day or two to process a claim; now it’s processed back in the batch folder within an hour,” McDonough says.

As a result, McDonough is confident Duplitron will be able to repeat this success with its other billing and coding clients. “We’ve already got four other clients using the electronic lockboxes to capture everything on the front end, so we can show them what PPS is doing and use that as a template.”

Meanwhile, PPS’s IT Director is impressed. “She’s worked in healthcare industry many years and never had a product that’s been able to do everything it says it can do.” Now, he adds, she’s asking how Workflow can be used as an accounting tool. “They want to use an exceptions report to reconcile claims, almost like a balance sheet,” McDonough says.

“This project has evolved has from a document management solution to a business process management solution—it’s true ECM from a claims perspective and BPM from a CFO/accounting point of view,” he concludes.

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

The Paper Pit

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

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

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

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

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

Serious Savings

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

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

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

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

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

Unexpected Benefit: Laserfiche Enables a Remote Workforce

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

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

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

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

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

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

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

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

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

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

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

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

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

We have so many customers out there who use Laserfiche in innovative and creative ways to make their budgets stretch as far as possible. Here are some examples.

Bakersfield, CA Bakersfield uses Laserfiche in all 19 of its city departments, as well as to provide documents to citizens over the Web. Thanks to Laserfiche, most public information requests are “D.I.Y.,” so when staff leave or retire, they don’t have to be replaced with new hires. And because the city has integrated Laserfiche with their GIS application, ArcIMS from ESRI, and their ERP application, Sungard Naviline, the savings are even more apparent. “With Laserfiche, you get more bang for the buck than with other imaging systems,” IT Director Bob Trammell says. “And when you make Laserfiche available to all your city departments, not just the City Clerk, that’s when you really begin to realize the benefits.”

BC Biomedical By scanning in the more than 10,000 patient requisitions received daily, BC Biomedical eliminated more than 25 hours a day spent filing original documentation. “The old way of doing things around here was extremely time-consuming and ineffective. Laserfiche has allowed us to multitask across several departments. I cannot stress enough how reliable, fast and easy the system is,” saysBusiness Systems Analyst/Project Manager Chris Fiorucci.

Bloss and Dillard, Inc. Quick Fields automatically creates the repository’s folder structure, files documents in the appropriate folders and sends policies to the appropriate underwriters. Without Quick Fields, staff would have to manually locate each folder after scanning it into Laserfiche. This automation saved 20 minutes per policy, resulting in more than $23,000 in saved labor costs.

Eaton County, MI, Prosecutor’s Office After implementing Laserfiche, the prosecutor’s office withdrew their request for an additional legal secretary, only one month after beginning to scan felony files. Additionally, they saved more than $10,000 in clerical staffing costs, and decreased office supply usage by nearly 35%. “These additional savings are annual, not one-time savings,” Jeffrey L. Sauter, the county’s prosecuting attorney comments. “In fact, I expect my supplies budget to decrease even more next year.”

Elk River, MN, Police Department Chief Jeffrey Beahen and his department saved more than $17,000 just in paper costs while realizing more energy and resources savings than they expected. When combined with budget cuts and man hours spent on other tasks, the savings really add up.

Feenan Financial Group Firm founder Tom Feenan discovered that he was spending $13,000 per year to rent space for file cabinets. Since implementing Laserfiche, they’ve eliminated the file cabinets and used that space as an office for a revenue-producing advisor.

Iredell Memorial Hospital Before Laserfiche, Iredell had to write off $40,000 per month due to lost and misplaced records. Now? They’ve reduced paper usage by 80% and eliminated lost records—and the write-offs that go along with them.

Meg Green & Associates Todd Battaglia, partner with Meg Green & Associates, a firm which manages $600 million in assets, saves $35,000 to $40,000 per year with Laserfiche. In addition, Laserfiche saves the firm an additional $8,000 a year by reducing filing space, so they could turn a former file room into an office for an advisor.

Rehmann Financial For this dually-registered RIA firm with 13 offices in 2 states, Laserfiche has streamlined workflow enterprise-wide, but it’s their compliance department that’s seen the most immediate, discernible benefits. As Operations Manager Amy Flourry explains, “Our compliance staff are now doing audits remotely, whereas before they would have to travel to all the other offices. We’re saving on mileage, hotel costs, time out of the office, meals—a whole laundry list of expenses that we’ve reduced just by using Laserfiche.”

Surrey, BC The city of Surrey Planning and Development Department issues 100 building permits per week, generating anywhere from 60 to 100 records related to each property and a minimum of 6,000 records weekly. By using Laserfiche, the department estimates they’ve reduced search and retrieval costs alone by $30,000 to $50,000 annually.

Wichita, KS Using Laserfiche as the foundation of their Web-based accident reporting system, the city of Wichita saved 50 to 60 staff hours and was able to raise fees by delivering an online service with immediate value. Wichita now charges $16 for each report, and charges to insurance companies have also increased from $2 to $16 per report.

Xpyria Investment Advisors Xpyria, an investment advisory firm that works with high-net-worth individuals, didn’t just save money by using Laserfiche to eliminate off-site storage. “We always figured we’d have to hire more people to create the efficiency we needed,” President and CEO Joseph Salpietro remembers. “We’d talked about needing two or three administrators over the next five or so years at a cost of, say, $30,000-40,000 each. And when we found out that we didn’t have to hire those people to help us with the paper chase—well, that’s a smart business decision.”

Have you realized tremendous savings from your Laserfiche system? Let us know! We’re always interested in hearing from the Laserfiche community. If you’d like to share your story, I encourage you to comment on this post or e-mail me at melissa.henley@laserfiche.com.

Remember: the savings are out there.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Situation

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

The Solution

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

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

Up and running in two weeks

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

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

Seamless storage and retrieval without paper

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

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

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

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

Remote access and distribution

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

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

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

Beyond the ER

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

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

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

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

Compliance

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

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

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

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

High paper pressure clogs medical biller

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

HP/Laserfiche solution passes the “stress test”

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

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

Clean bill of health since going live

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

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

Increasing vitality by going paperless

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

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

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

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

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

Building a healthy corporate lifestyle and boosting higher availability

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

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

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

Faster invoicing for clients, lower cost for Marina Medical

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“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.