Healthcare's need to know surpasses first-generation imaging systems

If you go to the bank and they can't find your records, that's annoying. If you're wheeled into the emergency room at 3 a.m. with chest pains and they can't find your chart, that could be deadly.

That's why healthcare facilities of all sizes are focusing on document imaging systems that will provide physicians with immediate access to documents. While many healthcare facilities have used document management systems for years, most have been imaging files after the fact--after patients leave the hospital.

The need to provide physicians with immediate access to records has also brought the issue of backfile conversion to the forefront. Having parts of files available on an imaging system while others must be accessed on paper or microfilm makes life difficult.

A patient's medical record is the starting point for a host of other activities--patient billing, documentation for insurance companies, medical research studies and clinical statistics. Ultimately, the information could be shared electronically with everyone in the healthcare circle--insurance providers, employers, pharmacies and patients themselves using the Internet. Invoices could be sent electronically from the hospital to the HMO, streamlining the payment process.

At the recent Internet World show, American Management Systems (AMS, Fairfax, VA) demonstrated a "concept" system that would provide access to a host of medical information--including patient records, prescription refill requests, health plan selection and reference information--via a Web browser with password access to sensitive documents.

That easy access to information is fueling a debate over confidentiality issues. Several government agencies and professional groups, such as the Computer-based Patient Records Institute (Schaumburg, IL) and the American Medical Association (Chicago), want to develop standards for security.

Next target: admissions

Londa Bechert, director of health information services at St. Vincent's Hospital (Indianapolis), says putting proper security precautions in place--such as restricting access to records based on password--makes it feasible to provide instant electronic access to records.

"As with paper and microfilm, precautions have to be taken to safeguard patient confidentiality," Bechert said. "Providing fast access to medical records--especially in the emergency department--was our number one objective, but we wanted to be sure we haven't compromised the security of those records, and we haven't," she said.

St. Vincent's has used document imaging technology from AMS since March 1995. The AMS system is based on document imaging and workflow technology from FileNet (Costa Mesa, CA). About 175,000 documents are scanned and 125,000 documents are retrieved weekly with the system.

The 769-bed hospital has 2,000 physicians and hospital staff users on a daily basis. It annually treats 32,000 inpatients and 872,000 outpatients, generating 13 million pages of paperwork a year.

According to Cliff Jaebker, chief financial officer, the system yields a 20% annualized return on investment, or a 36% return on investment excluding network costs. Savings have been realized throughincreased productivity and reduced storage and microfilm costs.

The hospital's next initiative is to bring the document management system to the admitting area, the first point of contact with the patient.

"This is one of our projects for the future," Bechert said. "If we could just capture paper at the point of entry it would streamline the process even further."

"Our emergency room physicians especially love the system," Bechert said. "Rather than waiting 20 minutes or even longer for access to records, all of the data on the patient's previous visits--including charts, lab reports and transcriptions--are available in seconds."

"It allows us to see what medication people are on ... when they've been here before, old X-ray reports, old EKGs, things that that would have taken an hour or more to get before from medical records are available instantly," said Ronald Johnson, a physician in the emergency room.

A new feature that is being developed would allow doctors to edit medical transcripts that are entered into the system from dictation.

"This would be a dream come true,'' said Bechert. "If physicians need to correct something in a transcript, they can do it through this system rather than sending it back through the process for editing."

The system has improved chart completion rates, Bechert added. When physicians sign on with their passwords, they are automatically presented with a list of charts that require their attention. The chart deficiency rate--the number of charts with missing information that cannot move to billing until a physician signs off--has decreased by half, she said.

Massive backfile conversion

Last fall St. Elizabeth's Hospital, a 500-bed facility in Covington, KY, completed a backfile conversion of about 2 million pages, a project that has added value to an already successful imaging system.

"This will make our document imaging system even more beneficial to our patients and our physicians," said Cathy McDannold, director of medical records services. The document management system from Optika Imaging Systems (Colorado Springs, CO) has cut record retrieval time from 30 minutes to less than five minutes.

The conversion of patient records--created prior to the imaging system--began in May 1997 and was completed in September 1997. The hospital contracted with Iconex (Cincinnati), a service bureau.

"We were going along as best we could, converting as much paper as we could, but we felt we needed to have the backlog of paper records on the system to get the full impact of the document management system, as well as to provide timely access to the total patient record,'' McDannold said.

The hospital had been scanning older records as they were accessed, adding them to patient files already stored in the document imaging system. But having portions of a patient's record on the imaging system and other portions on paper or microfilm made retrieval of older records slower and more difficult.

"A physician might not have immediate access to records that would show that a patient came in a month ago and was taking a medication that could impact the course of treatment," McDannold said.

Another benefit of the system, she added, is simultaneous access to records by multiple users. "In many medical situations more than one person needs access to the records to do their jobs,'' she said.

The hospital has been using imaging for about three years, running the Optika system on a Novell network with about 120 users. The hospital wants to expand the system to the human resources area and outpatient clinic.

"When we installed imaging, the plan was to have the system provide enterprisewide access to all types of documents, and that is certainly our goal," McDannold said