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.”

“Laserfiche has been handling EOBs (Explanation of Benefit forms) practically from the first day. The staff literally can’t believe how fast they’re finding patient information.

“One of St. Luke’s most interesting applications so far is in marketing, where one of the primary tasks is to put together visual presentations of their work, sometimes as a way to prepare patients for their surgeries.

“They’ve already scanned in thousands of photos. With the simple template that we built for them, they are able to find the shots they need in seconds. It used to take hours.

“With Laserfiche, they’re going to be using a similar template to archive video clips of actual procedures. It will make it practical for them to start producing full motion video presentations as part of their regular routine. The long-term potential is awesome.”

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

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

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

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

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

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

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

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

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

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

“I’m a one person department servicing six very busy doctors,” Ms. Goodyear says. “Laserfiche enables me to handle my insurance paperwork in a few hours every week. It used to take me three days.”

Ms. Goodyear has already had a hand in convincing one other eye care practice in the area to convert to Laserfiche, and has prompted no fewer than seven other medical practices to ask her Laserfiche reseller, Jerry Breitbarth of Westmont, IL-based TKB Associates, for demonstrations.

In addition, Ms. Goodyear caused a sensation when she told of her experiences with Laserfiche at the Chicagoland Chapter of the Professional Association of Health Care Office Managers (PAHCOM). “When I told them how much time I was saving, they couldn’t believe their ears,” Ms. Goodyear says. “Some of them literally ran up to me afterwards to find out how they could get going.” Not surprisingly, she and PAHCOM invited Breitbarth to make a full presentation on Laserfiche at one of their meetings.

“I’m involved with my counterparts at other practices because I hope to learn things from them that will make my job easier and better,” Ms. Goodyear says by way of explaining her outspoken support for Laserfiche. “So when I have something to offer that I think will really help them, I’m not going to hesitate to let them know.”