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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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