Document Management Presented by Laurel Schedin. 4 3 2 1 Introduction Where We (U of MN) Are Problem Identification/Potential Solutions Document Mgmt

Document ManagementDocument ManagementPresented by Laurel SchedinPresented by Laurel Schedin

4

3

2

1Introduction

Where We (U of MN) Are

Problem Identification/Potential Solutions

Document Mgmt (components, options, pricing, etc)

5 Where we plan to be (benefits, ROI, etc)

Introduction (and confessions)Introduction (and confessions)

• What I am hope to provide:– Overview of the situation we (University of

Minnesota) found ourselves in– Potential solutions we considered– Why we decided to go with Document

Management• Options within the product• Costs• Impact to hospital (positive/negative)• ROI• Time to implement, support, and maintain

Introduction (and confessions)Introduction (and confessions)

• Confession:– While we have everything in place, including the

trial database/indexing model and document type definitions, we have not yet implemented as we have experienced the dreaded project SLIPPAGE!

Where we (University of Minnesota) are:Where we (University of Minnesota) are:

• STATS:– We have outgrown our current facilities and have approximately

85,000 records stored offsite and adding approximately 5,000 annually. These records are either deceased patients or those who have not been seen in the last three years.

– Offsite storage cost is averaging $11,000 - $15,000 – Offsite storage decreases availability of medical record

information and increases cost and leadtime to access this information

– We have 2.5 - 3 FTEs in medical records with an annual estimated cost of approximately $125,000

– We have an estimated annual accession count of approximately 30,000. With an average of 8,000 of these being new cases

– Annual office supplies for paper, printing cartridges, year stickers, paper medical record, etc is estimated at $10,000

– We do not currently code or send to VMDB– IDC Canada report (2006) states that companies lose $14,000 per

employee year in wasted productivity due to lost and misplaced documents.


• In early 2007, the Veterinary Medical Center went live with electronic medical record (EMR) throughout the hospital which includes the electronic entry and storage of physical, history, TPR, weight, SOAPs, requests (labs, anesthesia, medical imaging, etc), request result reports, pharmacy, discharge instructions as well as the association of external documents to the patient/episode/request. While we are on EMR, we continue to maintain paper records for historical data as well as storing current information submitted by external resources (e.g. referring DVMs, external lab results).


• Through the use of EMR, the inefficiencies of the paper medical record have been magnified. While our current hospital information system (UVIS) does have functionality that supports linking to an external server for storing and accessing electronic documents, this functionality is not technically streamlined. The documents stored on the external server are not indexed and therefore are cumbersome and time consuming to store and access. We have experienced situations where a user is trying to access a PDF document and the Adobe product has timed out as it is taking the external server too long to find the document and respond. Thus we have limited our use of the external document functionality to only anesthesia and lab results.


• In April, 2008 we purchased high compacity scanners as part of our document management implementation. Having these decreased our scanning time for anesthesia forms from approximately 2-4 hours to 15 – 30 minutes

File away loose

paperwork

•Daily

Pick up charts &

loose filing

•Twice Daily

Prepping Charts for

Appts

•Daily – for next day

Process loose

papers in chart

•Daily

Chart

Pull

4-5

Process

Charts

4

Chart

Runs

4

Loose

Filing

3-4

Current Medical Records Processes:Current Medical Records Processes:

File backs

1

Place files back into shelves

•Daily

Respond to requests for information

and scanning

•Daily

Misc

?

Total potential steps

16 – 18+

Medical Records Processing Details PRE Document Management:


Misc calls for add on appointments/questions/request for file copies, etc

Requests:1) Add on appointment need file2) Locate file3) Request for information (client, RDVM, Legal, etc)4) Fax monitoring

Run report listing appointments for

next day

Look for and pull paper files for appointments

Search conference rooms and offices if files not available in medical records. Call DVMs and/or departments that

last saw the patient inquiring about file location

Take files to front desk

Check files out to Front Desk for Appt in UVIS

Chart Pull



Pick up files in return bins

Check files into Medical Records

in UVIS

Files put into processing shelf

CHART/LOOSE PAPERWORK PICK UP

Charts are processed and all papers filed according to protocol within paper record

All loose papers are:1) Checked for correct case #2) 2-hole punched3) Filed by date/admit within paper chart

CHART PROCESSING

Pick up loose filing from mobile cart

Organize by chart number

Pull charts associated with loose paperwork, place loose paperwork in chart and place entire chart into

processing shelf

Loose Filing

Files put into shelf for file backs

Place loose paperwork into mobile file cart for filing

File all charts in ‘file back’ shelf into medical records

main shelves

File Backs

Problem:Problem:

• We had implemented EMR, but were not fully electronic. This made it extremely difficult for clinical personnel to quickly and easily gain access to the FULL medical record.

• Resource requirements (human, software, hardware, and space) were all increased trying to support and maintain both electronic and paper medical record information.

Potential Solutions:Potential Solutions:

• Purchase more Novell servers and distribute external documents across

• Increase personnel to support paper and electronic

• Document Management• Do nothing

Document Management – what is it?:Document Management – what is it?:

• A Document management System is a software application that resides/runs on top of a server to organize, index and control access to the data on the server; This is all done at an enterprise wide level. It is like a secure electronic file cabinet. It allows you to capture, manage, store, retrieve, search and print documents all from a single point/application. It consolidates and expedites the management of data thus becoming a central repository for data no matter the format.

Document Management – What are the components?:

Document Management – What are the components?:

• Metadata• Integration• Capture• IndexingStorage• Retrieval• Distribution• Security• Workflow• Collaboration• Versioning• Publishing

Document Management – what are the benefits versus simply saving on a server?:

Document Management – what are the benefits versus simply saving on a server?:

• Documents can be easily scanned or faxed directly into and out of the document management system (with fax server)

• Scanned documents containing typed data will go through an optical character recognition (OCR) conversion making their text searchable

• Controls and logs all changes/access to a document• Creates and manages templates to ensure everyone is using

the current version• Locks files to prevent simultaneous changes to a document• Support searching document text using AND/OR logic

statements and the use of wildcards• Alchemy supports storing and accessing up to 550 different

types of documents/video in their native mode• Allows security administration at the Alchemy admin level

versus the server (IT) admin level

Document Management – How will this work with my existing infrastructure?:

Document Management – How will this work with my existing infrastructure?:

Paper document or

email

Paper document or

email

Paper document or

email

Paper document or

email

Scanner

Copier

Fax

Workstation

Server

Fax

Fax

Fax

Fax

Printer

Printer

Printer

Printer

Workstation

Workstation

Workstation

Workstation

Document Management – Sample Indexing & Document Types

Document Management – Sample Indexing & Document Types

• CASE NUMBER– Client Number

• Episode number– Referral Information

» Lab Work» Medical Imaging» History

– Estimate– Authorization– Treatment sheets– EKGs– External Lab Results– Specialty forms

» Ophthalmology» Dermatology» Oncology

Document Management – How much does it cost?:

Document Management – How much does it cost?:

University of Minnesota BudgetDescription

Cost

Alchemy Document Management System (1 content manager license, 1 administrator license, 2 index station client licenses, 51 client licenses, Alchemy scan (OCR conversion software), Alchemy web license, intelligent file cabinet(IFC) – unlimited user license)

$30,262

Maintenance & Support $5,447

Installation, Implementation & Training $2,160

Discount for being Beta site for IFC -$3,500

Total Document Management Cost $34,369

2 Robust wide throat scanners, 1 Desktop scanner and extended warranty $14,073

Total Project Cost (Doc. Mgmt and Scanners): $48,442

Document Management – What is success?:Document Management – What is success?:

• The success of the project will be evaluated/measured by the turn around time of data accessibility, the reduction in the number of processes required to access and maintain the VMCs clinical information, as well as an expected return on investment realized within two years of implementation.

• Upon full implementation (which includes the scanning of current patient historical records) the impact to the VMC should be quantifiable as follows:

– Medical records staff currently perform 5 processes totaling 16 steps for each patient visit. Once implemented, these numbers will be reduced to one process with five steps.

– The paper medical records is currently touched approximately 6-7 time per patient visit (initial file pull, front desk for admission, student/DVM for appointment, ancillary services or consults performed during visit, medical records pick up, medical record processing, filing the record back in the shelf). Once fully implemented this number will be reduced to three (front desk creates temporary file for paperwork associated to current visit, student/DVM seeing patient, medical records scans paperwork and recycles temporary file).

– Cost of electronic storage/access versus physical storage/access of medical record information

Medical Records Tasks POST Document Management

Medical Records Tasks POST Document Management

Client/patient check in with associated

paperwork from referring DVM OR

RDVM faxes information prior to

visit

Front desk places paperwork into

‘temporary’ plastic file with patient

label affixed to it

Temporary plastic file follows patient

through visit.

Medical records picks up temporary

plastic file upon patient discharge

Medical Records staff scan

paperwork and electronically

attach to patient record

5 steps

Medical Records Mgmt Ultimate Goal w/Scanners at Front Desk & Fax Server connected to Document Management:

Medical Records Mgmt Ultimate Goal w/Scanners at Front Desk & Fax Server connected to Document Management:

Client/patient check in with associated

paperwork from referring DVM

Paperwork gets scaned directly into document management

system (either by front desk or

medical records)

Based on database indexing

model and document type

information automatically files

Medical Records staff verifies indexing and

finalizes

Ultimate Goal

RDVM faxes information prior to

visit – Fax goes directly into fax

server (RightFax) that is interfaced with Document

Mgmt (Alchemy)

Document Management – So how do I justify this and what is the ROI?:

Document Management – So how do I justify this and what is the ROI?:

• Reduced costs– Save on hard costs (paper, copier/printer supplies, file cabinets, floor

space, offsite storage)– Administrative staff time

• Looking for information/files• Faxing• Processing

• Improved Efficiencies – Administrative staff time– Increase the accessibility and search-ability of information

• Increased Customer Service (clients, RDVMs, teaching, research, etc)• Compliance• Dollars Saved: $11,000 in offsite storage, $10,000 in paper and

medical records jackets,• When fully implemented this configuration and use of document

management systems can be replicated at any level (e.g. administration, department, collegiate, etc) throughout the college with minimal increase in costs.

• Note, implementing fax server and scanning prior to or with Alchemy increases the benefits exponentially

Document Management SystemsDocument Management Systems

• Alchemy• Captive• Esker• Stellant• Imagenow• Filenet (specializes in higher education)• Xerox Docushare• Computhink’s ViewWise• Hummingbird DM• KnowledgeTree• Laserfiche• Perceptive Software• SharePoint• Documentum

Additional ResourcesAdditional Resources

• RightFax and/or Alchemy ROI Calculator– www.captaris.com

• CMS Toolkit (costs $)– www.steptwo.com.au

QUESTIONS / COMMENTS? QUESTIONS / COMMENTS?

Laurel Schedin,University of Minnesota