DocFinity® Expedites Electronic Medical Records for Pennsylvania Medical Collective

Nearly every human being has experienced the challenges and frustrations caused by flawed or inaccessible paper-based medical records. These health records, which provide limited access to past medical data, often contain information that is disorganized and unintelligible. Information on patient charts can sometimes be incomplete or difficult to read, and lab results and reports are too often lost or misfiled. Elderly patients, or those who have had multiple symptoms or procedures, often have thick, jumbled paper files that are extremely difficult to navigate.

Healthcare systems that are dependent upon paper records are in drastic need of an overhaul. In a 2004 State of the Union address, President Bush called for the nation to eliminate paper medical records within a decade, citing that electronic records can "help change medicine and save money and save lives."

the push for electronic medical records (EMRs)

In response to this need, many healthcare agencies are considering the implementation of an electronic medical records (EMR) system. Current healthcare publications show that executives representing a majority of the healthcare industry are investigating ways in which to achieve this objective, moving from disparate systems for billing, clinical management, patient records, and back-office administration to more interoperable and integrated enterprise systems.

The benefits of a transition from paper records to electronic are many. The ability to immediately track, retrieve, and manage accurate patient information, both past and current, has tremendous implications for the quality and cost of patient care. The use of automated workflow can increase processing speed of documents requiring review, signatures, or other actions, while decreasing the potential for errors. Additionally, EMRs help healthcare organizations to comply with HIPAA and other regulations.

a healthcare collective takes its first steps

A collective of 50 healthcare practices in eastern Pennsylvania recognized for years the need to transition from paper patient records to electronic. They invested millions of dollars into a software system in 1998 to facilitate the creation of EMRs. However, a critical shortcoming surfaced: when users attempted to use the EMR system to integrate the scanning and storage of paper documents, they found it to be extremely inefficient. They soon realized that in order to reap the full benefits of their EMR system, they would have to make some modifications.

lag time and errors

After implementing the EMR system, it was discovered that the software was designed more for creating new records than for scanning and storage. Consequently, practices within the collective experienced a variety of shortcomings when they tried to perform document scanning and retrieval operations. Users were frustrated because the process for capturing information was time-consuming and cumbersome. They had to open individual records, manually scroll down through each chart, find the appropriate section, and then perform the scanning operations. This was a tedious manual process that required several minutes per page. Storage, too, was problematic, as the existing system required a tremendous amount of storage space. Equally disheartening was the fact that this process was prone to user error; users often scanned the wrong parts of patient files. Finally, the quality of scanned images was often poor, leading to long retrieval times for images (more than 30 seconds per image).

The overall time frame for capturing documents and making them available electronically was often lengthy—sometimes two weeks or more. In addition, the system was not equipped to handle other pertinent documents and information that was not associated with a medical record or order number. Information (documents) could not be retrieved directly (e.g., based on a search of index values) without working through the EMR interface. Whereas the EMR system was adequate at making patient records from information that was already electronic, it did not meet the group’s needs for integrating paper records, emails, faxes, and documents into the EMR system.

an integrative plan

In the fall of 2003, the Project Leader for the healthcare collective spearheaded an initiative to address these shortcomings. She contacted a local consulting and document management solutions company, who performed an analysis of the collective’s business processes. An integrated solution was proposed that involved the addition of two key components to the existing EMR system: a specialized scanning system and a state-of-the-art document management system. These components had to be flexible enough to work with the EMR Application Programming Interface (API), which allows other programs to request EMR services.

The consultants helped to design the EMR API in an effort to accommodate the new integration. The components also had to have the ability to interface with the collective’s HL7 converter. The HL7 converter handles basic components of HL7 communication, maps HL7 messages into a database, and delivers HL7 interface solutions. Essentially, it standardizes what were formerly proprietary health-related data systems so that they can communicate with other systems.

For the first part of the solution, the consultants recommended using an industry-leading third-party capture application to classify and validate scanned documents. Once integrated with the EMR system, the capture system significantly decreased scanning time and reduced the potential for errors.

the DocFinity solution

The second part of the solution involved the ability to manage documents on an enterprise basis successfully. The consultants proposed the DocFinity suite from Optical Image Technology, Inc. (OIT), an industry-leading electronic document management (EDM) system. The consultants’ recommendation was based on the flexibility of the features offered with the DocFinity suite, as well as its ability to offer the same (or better) functionality as applications that can cost literally twice as much. OIT understood the collective’s business problem and came up with a customized solution to meet their specific needs. The DocFinity suite of software was chosen from a field of five vendors because of its robust architecture and its technical capability, as well as its realistic pricing structure.

The collective uses DocFinity to store EKGs, lab results, consultation letters, HIPAA forms, and other documents that comprise patients’ files. After information is scanned, it is stored in the DocFinity electronic storage repository. DocFinity’s HL7 module ensures that information is communicated in an industry-standardized format. Since DocFinity is optimized for speed in the search, retrieval, and display of document images, virtually any and all paper information that is produced and received by the collective is scanned and stored in the DocFinity repository.

initial hurdles

The biggest hurdle, initially, was the scope of the project. The transition involved integrating a system across several networks with different user groups and medical practices. It also changed the ways in which users operated the system, managed technology, and completed processes over time.

users’ impressions of the solution

Currently, a developer oversees the integration as it is rolled out to other practices within the collective. Ten of the fifty medical practices in the collective are already using the DocFinity/EMR solution. The anticipated timeline to extend the technology to all 50 practices is expected to take place over several years, since the rollout of the capture and document management system must trail the rollout of the EMR system to the individual practices.

By all accounts, the new system is significantly faster. The third-party capture software has improved the collective’s imaging capabilities considerably. Users now have the ability to scan in batches, and are no longer relegated to page-by-page scanning. Because DocFinity and the capture software both have the capability to integrate with the collective’s EMR system via HL7, users no longer experience scanning inconsistencies and errors. Page-by-page scanning has been replaced with the ability to scan in batches, in semi-automatic fashion. Scanned records are stored in the DocFinity repository, which supports medical records and other folders and files. DocFinity’s organizational abilities eliminate previous complaints. Since DocFinity is sized for the collective’s volume and scaled to grow with the medical practices, storage and retrieval is a breeze.

return on investment:

Since the integration of DocFinity, the collective has realized significant benefits. Scanning throughput for full-time employees has increased by 17%, while help desk calls about scanning problems have decreased. Staff training time on software applications has been cut from two hours to one half hour, and retrieval speed has increased significantly. Where retrieval used to take up to forty seconds, it now takes less than five seconds. Due to changes in image compression type, scanning no longer has to compete for processing resources on the retrieval/viewing server. As the current developer notes, “It took forever to find an image using our original system, and finding that image was often cumbersome. It is significantly faster and easier to find images using DocFinity.”