How Symbria Inc. Uses Laserfiche to Streamline Plans of Care for Patients

Laserfiche Solution Contributed By: Hien Do, Software Development Manager; Boris Remus, Senior Software Engineer, Symbria Inc.

Symbria Inc. provides therapy services to hundreds of skilled nursing facilities. The organization was challenged with manual paper processing prior to implementing Laserfiche. One area that was especially paper heavy and inefficient was obtaining the required physician signatures and dates on the patient plans of care forms.

Within 30 days from the start of a patient’s care, their treatment plan must be approved by a physician or reimbursement for the treatment may be denied. Previously, the Rehab Program Manager printed a patient’s plan of care from the therapy software. The plan of care was then hand delivered or faxed it to the appropriate physician for a signature. Once the signatures were obtained, the Rehab Program Manager scanned in the plan and attached it to the patient’s record back into the therapy software. The program manager would also have to fax or hand-deliver the plan of care to the medical records department at the facility in order for the payments to be processed correctly.

Rehab Program Managers, who are highly trained therapists themselves, spent a lot of their time performing administrative tasks like tracking which documents haven’t been signed and following up with physicians who did not sign the plans of care. Facilities vary greatly in size which means some process a small number of documents a week, while others can process in excess of 100. This volume resulted in a significant amount of program manager time investment.

Symbria evaluated the entire process and decided to use Laserfiche to optimize it. The current process transfers most of the work from the Rehab Program Manager to the staff at the corporate office and uses Laserfiche Forms and Workflow to automate routing and faxing.

The Plan of Care is Routed and Faxed Electronically

The new process still starts with the Rehab Program Manager generating the plan of care document, but now, he or she uploads it to a Laserfiche form. From there, everything is handled by staff at the corporate office.

Once the plan of care is uploaded and the form is submitted, the plan of care is saved in the repository and Laserfiche Workflow creates and stamps a barcode onto the document. The barcode uniquely identifies the plan of care. Workflow then runs a series of checks to make sure that the information in the plan of care is correct. Workflow checks that:

  • The physician identification number has 10 digits
  • The patient name is valid
  • The therapy discipline is valid
  • The date is valid

 

If the plan of care does not pass all the checks, then it must be validated manually. The corporate processing staff performs the validation task in Laserfiche Forms.

Once the plan of care is validated, Laserfiche Workflow looks the physician up in the database to obtain his or her fax number. The document is then faxed digitally to the fax number using a faxing service.

When the physician signs and faxes the document back, Symbria receives an electronic version of the document from the fax service that is then imported into Laserfiche using the Import Agent. Workflow reads the barcode to associate the document with the original and routes it to the processing staff at the corporate office to verify the document is correctly signed and dated. Once that step completes, the processing staff attaches the document to the patient’s record in the therapy software and Workflow sends a copy to the medical records department at the appropriate skilled nursing facility.

If the physician doesn’t return the plan of care in a timely matter, the corporate staff member gets a task assigned to him or her in Forms to follow up with the physician. When opening the task, the staff member sees helpful information, such as the physician’s fax and phone numbers. The physician is also automatically notified through Workflow on a regular basis if he or she hasn’t sent back the signed plan of care.

Automation Saves Each Facility an Average of Five Hours a Week

On average, with this automation, each facility saves five hours a week by not having to manually fax and deliver plans of care. The largest benefit, though, is that the Rehab Program Manager no longer has to obtain physician’s signatures. Instead of chasing physicians down, the Rehab Program Manager can focus more on patient care. Laserfiche also gives the company stringent control over document access, which is a must in the heavily regulated healthcare industry.

Alabama Department of Mental Health Digitizes Patient Records

The Alabama Department of Mental Health provides critical services to over 200,000 patients annually at hospitals and clinics across the state. With medical archives dating back over 150 years, the agency must manage patient data in a manner that enables staff to easily and quickly find the information they need.

Implementing Agency-Wide Records Management

“The American Recovery and Reinvestment Act asked all organizations, such as ours, to demonstrate meaningful use for information and have electronic health records to keep funding with Medicare and Medicaid,” said Cindy Shrum, Director of Information Systems. “We want to maintain our Medicare or Medicaid funding, but having an electronic records management system is also just easier. We’re able to get the information when we need it.”

Upon the recommendation of the State of Alabama, the agency selected Laserfiche as its records management solution. Laserfiche’s ease of use and competitive pricing meant the department could more productively use federal funding to create an agency-wide records management system for patient records.

Improving Patient Care through Staff Efficiency

The department partnered with the state, which was already using Laserfiche, to procure the software; this partnership also shortened implementation time and improved data sharing. The department has since digitized all medical records at Bryce Hospital, the state’s oldest and largest inpatient psychiatric facility.

“We’ve got them organized so you can see the physical history, the summary, and the progress notes,” Shrum says. “What I like about Laserfiche is that in just three clicks, we’re in the electronic health record. For a clinician, especially our doctors, that time matters to them.” Benefits include:

  • • Eliminated the need to build a warehouse for patient archives, freeing up additional funds for patient services
  • • Created efficient process to automatically digitize, organize and file full charts of new and archived patient data in a shared repository accessible to clinicians and nurses across departments
  • • Integrated document management with the agency’s CoCentrix medical system eliminates repetitive data entry
  • • Increased compliance with federal laws, ensuring continued Medicaid and Medicare funding

These financial and operational improvements have ultimately enabled the Alabama Department of Mental Health to provide better quality health care and a greater volume of patient visits. “We started out small, but the potential is unlimited,” Shrum says.

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Saving $1.5 Million with Laserfiche

SEPT is one of the largest and highest-performing national healthcare organizations in the United Kingdom. Providing services for people with mental health problems and learning disabilities, SEPT serves a population of 1.5 million across three counties, with over 3,500 employees and an operating a budget of more than $300 million.

Mergers and acquisitions account for much of SEPT’s growth, but innovation, says Dominic Malvern, Head of Information Systems Development, accounts for much of its ongoing success. “It’s never been a stereotypical government ‘Mental Health Organization,” Malvern says.

In fact, when SEPT transitioned from a purely state-funded trust to a more privatized “Foundation Trust,” one of its primary initiatives was to partner with Adobe to develop an EMR system using Adobe LiveCycle products supported by a Laserfiche ECM system from Laserfiche reseller Fortrus. Malvern saw the chance to hit the ground running with a pilot project in the trust’s Forensic Services Department, which was moving to a new building as part of a modernization program.

“It was the ideal opportunity for us to modernize how our live patient records were accessed, as it was apparent that continuing with a manual process was not in keeping with the state of the art service we provide to our patients,” he says. That process, he adds, had remained manual by default because the legacy imaging system in Forensics didn’t meet the Trust requirement for working with live patient records.

“A single patient record could run for several years, sometimes through a person’s entire adult life, so it would extend into several volumes,” he explains. “Constant patient monitoring meant frequent updates to records for many reasons such as observation or treatment plans, sometimes every 15 minutes.”

A Pilot That Needed To Fly 24-7

When choosing a department to establish proof-of-concept before deploying a full-scale EMR system, SEPT couldn’t have chosen a more challenging one than Forensics Services—or one in which the impact of a successful ECM implementation would be so pronounced.

Malvern worked with Fortrus’ Steve Livermore to implement a Laserfiche pilot system for active patient records management system using:
  • Laserfiche Quick Fields advanced capture to input, sort and file the steady stream of patient information.
  • Laserfiche Workflow to automatically route information for reviews, approval and distribution.
  • Laserfiche Web Access to allow both remote deployment and access to the system over SEPT’s broad geographic service area and affiliated agencies.

SEPT implemented a clinical pilot project in 2009 and, over the course of a year, the new system kept up with the staff’s round-the-clock demands, amassing over 500,000 documents in the Laserfiche repository in the process.

Malvern says the real operational breakthrough was having a system aligned with the increasing need for information sharing between regional service offices. “Increasingly we have to work on a multi-disciplinary and multi-agency basis, so having shared but secure access to patient records and notes is vital,” he says.

From an IT perspective, Laserfiche Web Access gave the organization one more tool to centrally control system administration while capitalizing on Laserfiche’s flexibility to configure various access levels remotely.

“Being able to deploy the system through our server or using web browser options allowed us to control the type of access we wanted to make available,” says Malvern. “Web-based deployment is key because of the ease of maintenance when working with such a large group of users. Updates and upgrades would be unwieldy to deploy with a large number of single desktop clients.”

Going from EMR to ECM Saves $1.5M

The vision to extend Laserfiche from its supporting role in SEPT’s EMR project to a full-scale ECM deployment came with the support of Fortrus’ Livermore, who helped Malvern make the case to SEPT’s directors to implement Laserfiche for the trust’s non-clinical side.

“Once I heard the directors were looking at other solutions, and knowing what Laserfiche was capable of, it seemed a waste to restrict its application to purely clinical processes,” says Malvern. “Of course, it seemed an even bigger waste to spend further public money on more software that would be superfluous when we had a perfectly good system that would likely be better than anything else on the market.”

Now moving ahead with full-scale deployment of its Laserfiche Rio system to what will eventually be 3,000+ users, SEPT is effectively standardizing its information management on Laserfiche, eliminating the need for multiple departmental systems—and their corresponding service agreements and upgrades.

“Initially Laserfiche was envisaged solely as a clinical and medical records solution, but we have now realized that it can be a complete multi-functional document management system for the whole organization,” he says.

“We’ve begun implementation in non-clinical areas such Human Resources and Finance, as well as Vehicle Service Management, where we’re using Laserfiche Quick Fields and Laserfiche Workflow to automate our lease applications.” Additionally, another major project is underway to use Laserfiche to meet retention regulations for information governance of corporate records.

“From a roll-out prospective, it makes life much easier to have one multi-tasking system that all employees are trained on no matter what their function. It makes live support a far more streamlined and efficient activity,” he explains.

Malvern says the efficiency—and cost-savings—are starting to add up. “Within 18 months to two years we’ll be able to replace all our legacy imaging systems with Laserfiche. Implementing Laserfiche and its enterprise licensing enables SEPT to discontinue several annual contracts and service agreements. It also delivers savings on labor and print costs for information requests, as well as paper document archive and retrieval services. Realistically, this will save us US$1.5 million over the next three fiscal years,” he says.

SEPT’s Run Smarter Philosophy

Malvern’s advice for successful implementation and adoption from his experience with SEPT’s jump from departmental EMR to organization-wide ECM is simple. “Be open-minded in your approach. Don’t just try to replicate what you already have; Laserfiche can do so much more! Even a year down the road we’re still discovering new things it can do for us. It has great functionality combined with enormous flexibility that’s capable of revolutionizing your whole approach to records and document management—both live and archival,” he says. “We wish we’d discovered it sooner!”

Computerized Management Services

For Computerized Management Services, a medical management company that focuses on meeting the needs of radiologists, technology paves the path to a profitable future.

“Because we’ve never lost a customer and have extremely low employee turnover as well as strong long-term relationships with all of our key suppliers, we have the means to invest in the technology necessary to build a world-class infrastructure to meet the future needs of our clients,” says President Tom Brajkovich.

This forward-thinking approach led the company to implement Laserfiche enterprise content management back in 2006. “There’s a lot of miscellaneous paper associated with medical billing, a lot of non-standardized communications coming from patients, payers and providers,” Brajkovich explains. “We knew that digitizing the paper and automating associated processes would make us more efficient.”

Prior to implementing Laserfiche, Computerized Management Services housed its paper archives in bankers boxes at offsite storage lockers, making it difficult for staff to find older documents. Files that had yet to be reviewed for coding and billing purposes were kept in filing cabinets, creating bottlenecks when documents were misplaced and limiting the management team’s visibility into the company’s overall workflow.

To facilitate access and improve productivity, the company now uses Laserfiche to process, manage and store four main document types:
  • Reports and face sheets from providers.
  • Explanation of benefits forms (both paper and electronic) from payers.
  • Credentialing documents from providers.
  • Internal training documents.

“We’re constantly scanning, uploading and processing information,” Brajkovich says.

Documents are processed and stored using Laserfiche Quick Fields 8, a high-volume capture and processing tool, and Laserfiche Workflow 8, a business process management tool. These tools eliminate the need for manual data entry and filing by:
  • Automatically extracting metadata from documents.
  • Auto-populating index fields.
  • Creating new folders.
  • Auto-filing documents.

For a company that receives thousands of documents a day from more than 100 locations in California and Arizona, this automation results in a big productivity boost. It also makes it easy for employees to retrieve documents by conducting simple field and text searches.

Processing EOBs with Laserfiche

Further enhancing productivity, Computerized Management Services uses Laserfiche to manage the explanation of benefits (EOB) forms that most insurers still send in paper format.

“We use Laserfiche Quick Fields to convert paper EOBs into usable data, and Laserfiche Workflow to facilitate EOB processing,” explains Denise Van, Vice President of Operations.

Via document shortcuts, the company uses Laserfiche Workflow to route EOBs to the appropriate client teams for processing. Client team personnel work with dual screens, so they’re able to view a document on one screen while performing data entry into the company’s CPU billing software on the other.

Although CPU and Laserfiche aren’t yet integrated, the Laserfiche Entry ID for each document is logged in each patient’s record in CPU so that it is easily retrievable. After the EOBs have been processed, Laserfiche Workflow removes the EOB shortcuts from the client team folders. Laserfiche Workflow then archives the EOBs by date of service.

Laserfiche Workflow Automation Accelerates Coding

Computerized Management Services also uses Laserfiche in conjunction with A-Life, its computer-assisted coding system.

When the company receives new information from a client site, it imports it into Laserfiche using either Laserfiche Import Agent, which captures electronic faxes, or Laserfiche Snapshot, which converts electronic documents into TIFF images. Documents are then processed by Laserfiche Quick Fields and exported to A-Life. Once documents have been coded in A-Life, Laserfiche Workflow archives the documents.

The biggest benefits of Laserfiche, however, are felt when the company can’t use A-Life. “If a facility changes the format of its reports or face sheets, it takes time to reprogram A-Life,” says Brajkovich. “When that happens, Laserfiche takes over.”

According to Van, employees need a mere 24 hours to complete the coding process in A-Life. When done on paper, the process takes 5-10 days. When used as the company’s “coding back up,” Laserfiche enables staff to complete the coding process in 48-72 hours.

“Laserfiche helps us solve problems,” says Van. “If we had to code on paper every time a facility changed its format, we’d lose a lot of time.”

The coding process in Laserfiche works as follows:
  • Documents are imported into Laserfiche using Import Agent or Snapshot.
  • Documents are processed by Laserfiche Quick Fields, metadata is applied and Laserfiche Workflow moves document shortcuts to the Coder folder for processing.
  • The coding manager assigns work and Laserfiche Workflow moves the folder to the assigned coder.
  • The assigned coder codes the document using the preview pane in Laserfiche, adding coding metadata to the Laserfiche template.
  • Laserfiche Workflow then moves the document to the billing team, which exports it to CPU for processing.
  • Once the completion criteria have been met, Laserfiche Workflow archives the documents.

“Laserfiche Workflow is a wonderful tool,” says Van. “We rely heavily on it.”

The Key to Going Digital

Brajkovich and Van stress that Computerized Management Services’ success with Laserfiche is the result of a phased approach to implementation and training. They first worked with Laserfiche reseller JPI Data Resource to configure the system to their specifications, and then they trained their staff.

“We didn’t roll out everything at once,” says Brajkovich. “Implementing the capabilities of Laserfiche slowly allowed us to make sure that adjusting to the new system didn’t slow us down.”

Initially, staff learned how to use Laserfiche to search and retrieve digital documents. Once the company rolled out Laserfiche Workflow, Brajkovich and Van took a train-the-trainer approach, working with key staff from the data processing and client teams to ensure that they were comfortable with the system and able to show their team members how to perform their various tasks.

Today, as always, the company is in the process of improving its workflows. “Continuous improvement is important to us,” says Brajkovich. “In order to ensure that we offer truly exceptional service to clients in the heavily nuanced field of radiology, we constantly look for ways to fine tune our processes and our use of technology.”