Optimized Document Management Optimized Document Management in Anatomic Pathology – Two in Anatomic Pathology – Two

Paths to a Common Workflow with Paths to a Common Workflow with Analysis of BenefitsAnalysis of Benefits

Mark Routbort MD PhDMark Routbort MD PhD11; Erin ; Erin Grimm, MDGrimm, MD22; Rodney Schmidt MD ; Rodney Schmidt MD

PhDPhD22. .

11Department of Hematopathology, MD Department of Hematopathology, MD Anderson Cancer Center, Houston, TX; Anderson Cancer Center, Houston, TX; 22University of Washington, Seattle, WA.University of Washington, Seattle, WA.

ImperativesImperatives

Operate more efficientlyOperate more efficiently Facilitate information flowFacilitate information flow Preserve recordsPreserve records

Paper is cheap and records are stable Paper is cheap and records are stable but there are high indirect costs but there are high indirect costs associated with using and managing associated with using and managing paper.paper.

What are the benefits of What are the benefits of document imaging?document imaging?

Scan case Scan case paperworkpaperwork Instant availability Instant availability

of original of original paperwork Easily paperwork Easily implementedimplemented

Permanent storagePermanent storage Quick retrievalQuick retrieval No xeroxing!!!No xeroxing!!! No paper storageNo paper storage

What are possible workflows What are possible workflows for scanning?for scanning?

Paperwork generatedby surgeon/clinician

Case accessioned

Grossing

Micro/Final

Signout

Coding and Billing

Consult Slides and PaperworkReceived

Micro/Final

Signout

Coding and Billing

Inside Cases Consult Cases

= Possible places to scan documents

Baseline stateBaseline state

UWMCUWMC Paper records only (no scanning)Paper records only (no scanning)

MDACCMDACC Paper sent to outside service for scanning after Paper sent to outside service for scanning after

cases were signed outcases were signed out

Both used PowerPath v8.3 (Impac) with Both used PowerPath v8.3 (Impac) with Imaging licenses (engineered for gross and Imaging licenses (engineered for gross and micro images). Scan via TWAIN interface, micro images). Scan via TWAIN interface, store, display with case.store, display with case.

UWMC ApproachUWMC Approach

Scan paper using native PowerPath Scan paper using native PowerPath functionfunction Consult cases at accessioningConsult cases at accessioning Inside surgicals after signoutInside surgicals after signout

Cost-benefit analysisCost-benefit analysis Directly measurable benefitsDirectly measurable benefits User surveyUser survey

Custom middleware to improve workflowCustom middleware to improve workflow

Document accumulation - Document accumulation - UWMCUWMC

Scanned documents

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57

Week

Cu

mu

lati

ve

im

ag

es

How does scanning help How does scanning help workflow?workflow?

Paperwork is instantly availablePaperwork is instantly available Pathologists/Residents don’t spend time Pathologists/Residents don’t spend time

searching for paperwork during:searching for paperwork during: Case signoutCase signout Conference preparationConference preparation

Off-site coders have access to original Off-site coders have access to original paper during billingpaper during billing

UWMC – Financial AnalysisUWMC – Financial AnalysisPaperPaper ScanningScanning NetNet

ConsumablesConsumables $291$291 $0$0 $291$291

PersonnelPersonnel $2,200$2,200 $2,111$2,111 $89$89

Lease/licensingLease/licensing $0$0 $70$70 ($70)($70)

Computer Computer disks/tapedisks/tape

$0$0 $12$12 ($12)($12)

UWMC – User survey UWMC – User survey after implementation of after implementation of

document scanning systemdocument scanning system

Satisfaction Satisfaction

(1-5)(1-5)Time savedTime saved

(min/day)(min/day)

AccessionersAccessioners 2.52.5 -60-60

Office staffOffice staff 1.01.0 60 60

PathologistsPathologists 1.51.5 8686

ResidentsResidents 1.41.4 145145

Documents – Benefits Documents – Benefits

Direct benefits lowDirect benefits low Takes longer to scan than copyTakes longer to scan than copy Primarily due to system login, navigationPrimarily due to system login, navigation

Indirect benefits high (35 hrs/wk)Indirect benefits high (35 hrs/wk) Instant 24 x 7 availabilityInstant 24 x 7 availability No paper retentionNo paper retention Easy conference preparationEasy conference preparation

Integration with PowerPathIntegration with PowerPath

Custom Middleware - UWCustom Middleware - UW

Facilitates document scanning workflowFacilitates document scanning workflow Avoids multiple loginsAvoids multiple logins Bypasses navigation to cases in PowerPathBypasses navigation to cases in PowerPath TWAIN interface to scannerTWAIN interface to scanner Single- and multi-sheet modesSingle- and multi-sheet modes

Direct insertion of scanned images into Direct insertion of scanned images into PowerPathPowerPath

Post-middleware surveyPost-middleware survey

Accessioners liked using itAccessioners liked using it Subjective average score 10.0/10Subjective average score 10.0/10

Document scanning process is fasterDocument scanning process is faster Subjective average score 8.3/10Subjective average score 8.3/10 Saved 0.25 min/caseSaved 0.25 min/case

Doing additional work (renaming images)Doing additional work (renaming images) Scanning cases in batches (minimizes login Scanning cases in batches (minimizes login

and navigation benefits)and navigation benefits)

MDACC ApproachMDACC Approach

Bring scanning in-houseBring scanning in-house Custom middleware to facilitate Custom middleware to facilitate

scanningscanning Motivated by anticipated workflowMotivated by anticipated workflow Avoid multiple logins and PowerPath Avoid multiple logins and PowerPath

navigationnavigation TWAIN driver for scannerTWAIN driver for scanner Direct insertion of images into PowerPathDirect insertion of images into PowerPath

Assess benefitsAssess benefits

Documents scanned per day - MD Anderson(staged implementation)

0

200

400

600

800

1000

1200

1400

3/4/2006 3/24/2006 4/13/2006 5/3/2006 5/23/2006 6/12/2006 7/2/2006 7/22/2006

Outside pathology paperwork

Accessioning paperwork

Outside hemepath paperwork

Benefits - MDACCBenefits - MDACC

Cost avoidance of >$50,000/yrCost avoidance of >$50,000/yr Timely archiving of paperworkTimely archiving of paperwork Eliminate scanning of unnecessary Eliminate scanning of unnecessary

and redundant documentsand redundant documents Universal access to archived images Universal access to archived images

through PowerPaththrough PowerPath Indirect utilization benefits similar to Indirect utilization benefits similar to

UWUW

ConclusionsConclusions

UWMC and MDACC both achieved large UWMC and MDACC both achieved large direct and indirect benefitsdirect and indirect benefits

Optimal workflow is key – both compelled to Optimal workflow is key – both compelled to write middleware to improve scanning write middleware to improve scanning workflow workflow

Integration with the AP-LIS (PowerPath) is Integration with the AP-LIS (PowerPath) is enormously beneficialenormously beneficial

WorkflowWorkflow is key is key DigitizationDigitization of data is beneficial of data is beneficial

FutureFuture

Scan all paperwork at the time of Scan all paperwork at the time of accessioningaccessioning

Real-time availability while case is in Real-time availability while case is in processprocess

Concurrent availability (e.g. transcription, Concurrent availability (e.g. transcription, coding, resident, pathologist)coding, resident, pathologist)

Immediate archiving (no lost paper)Immediate archiving (no lost paper) Custom apps (e.g. gross room)Custom apps (e.g. gross room)

AcknowledgementsAcknowledgements

UWMCUWMC Kevin Fleming, Rosy Changchien, Kim Kevin Fleming, Rosy Changchien, Kim

Simmons, Paula Reeve, Phil Nguyen, Simmons, Paula Reeve, Phil Nguyen, Victor TobiasVictor Tobias

MDACCMDACC Mike Riben, Lori HeydonMike Riben, Lori Heydon