Scanning system boosts registration efficiency

Document history available instantly

Registrars at the University Hospital of Arkansas in Little Rock are saving time and paper and creating more accessible records by scanning patients’ insurance and health information into the computer, says Mary Nellums, CHAM, admissions manager.

"We’re scanning the documents on the front end, [including] insurance cards, driver’s licenses, and any kind of health information, such as letters saying a patient is approved for workers’ compensation," she adds.

At present, scanning is being done in central registration, the emergency department (ED), and by two registrars in the preoperative area as a pilot project, she notes. "Outpatient and off-site clinics are not included at this point."

The pilot began in early 2003, Nellums says, with the purchase of small, individual scanners for each registrar’s desk. Documents are scanned into different folders, depending on their use, she explains. "Everything that is an insurance document, such as a workers’ comp letter or an out-of-network exception, goes into the insurance folder."

Before, registrars put hard copies of the various documents in patients’ files, Nellums says, keeping them for six months to a year.

Under the new system, she points out, registrars immediately can see the history of a document. "After they scan in the driver’s license the first time [a patient is registered]," Nellums says, "when the person comes in again, [the system] will show it has already been copied once."

Registrars still ask for the license, but then compare it with the existing file and scan again only if something has changed, she notes. "It’s the same way with insurance cards. If there’s a change, [the file] will pop up and show us the previous one."

Changes in insurance coverage thus are preserved in the file, in order of occurrence, Nellums explains.

"It’s good for the billing department," she says. "[Billers] don’t have to call us and say, Do you have a copy of the insurance card for this patient?’ or Do you have a referral on this patient?’ Everyone who has EPF [electronic patient file] access can go into the account and pull it up."

Nellums developed a process tree showing which documents should be scanned into which folder. As registrars are scanning a document, she says, they are given the opportunity to select a folder for that document. "They just click and it scans the document into the folder."

"For two or three weeks, people were putting [documents] in the wrong place or not understanding [the process], but now it’s part of the routine," she adds. "It saves me a lot of time because they know [if something’s wrong], I’m going to come back and ask them to fix it."

There previously had been one large scanner in the central registration area, Nellums notes. Besides not being convenient for ED staff or those in other areas to use, she adds, it often was not operational, so that hard copies were routinely made and filed.

And with the individual scanners, Nellums says, employees don’t have to wait until they have documents from several patients and then make the trip to the scanner.

A few days before this year’s April 14 deadline for implementation of the Health Insurance Portability and Accountability Act privacy standard, registrars began scanning privacy notices into the system after patients had signed them, Nellums notes.

There was some initial confusion with that process, she says, having to do with indicating the different ways of providing the notice. Registrars may enter "notice provided," "notice mailed," or "urgent situation," for example, to describe the interaction.

The majority of the time, Nellums explains, registrars use "NP," for "notice provided," meaning they gave the notice to the patient, who in turn signed it. "Urgent situation" was created, she adds, to be used when the patient has been in an accident or for some other reason is unable to acknowledge the notice.

"In the beginning, it was hard to choose which one," Nellums says, "and [registrars] would use US’ with obstetrics patients."

ED registration revamped

In another innovation involving the ED, she notes, University Hospital instituted a new registration process in August 2003, with the dual aim of enhancing customer service and ensuring compliance with the Emergency Medical Treatment and Labor Act (EMTALA). 

In the past, Nellums explains, ED patients — except those who had chest pain or another life-threatening condition — came to the registration desk upon arrival, where an account was established and a full registration was done. Patients then were sent to triage, where a nurse evaluated them, she says.

Now all patients go first to the triage nurse, who does a quick registration, obtaining just name, date of birth, arrival date and time, Social Security number, race, sex, and chief complaint, Nellums says.

The quick registration sheet prints out in the registration area, she notes, saying, for example, "Patient has gone to Room 7." Registrars actually can see patients walk up for triage, as well, Nellums adds, and often are waiting at the printer so they can go immediately to do the registration.

"Our people go to the bedside and use the update function to fill in the additional registration information," she says.

Providing adequate registration training for the nurses is crucial to making the process work efficiently, Nellums advises. "I’m not sure our nurses received enough training to prevent [the issuing of] duplicate medical record numbers. We did a lot of cleanup on the back end."

"Nurses are geared more toward making sure the patients are taken care of than getting demographic information," she says. "At the beginning, they felt, We don’t want to worry about that.’"

Now, she adds, the number of duplicate records has "finally slowed down. We’re down to a couple of patients every other day for which we may find a duplicate."

Although instituting a quick registration process had been discussed several times in the past, Nellums says, it came to fruition with the arrival of a new ED manager. "It’s a big change for the staff not to have the patient come to them, but the majority of them now are geared to do it. They realize it’s more patient-friendly to go to the bedside."

Patients, in turn, "seem to feel they’re being treated better having people come to them rather than sitting in front being asked a lot of questions," she notes. "What I’ve observed is that once they’re in a bed and have had their blood pressure checked, [patients] are more prone to go ahead and give all the information more freely."

Once they’re more at ease and feel they’re being taken care of, Nellums adds, the patients aren’t as likely to try to limit the conversation.

[Editor’s note: Mary Nellums can be reached at (501) 686-6789 or by e-mail at Mary.C.Nellums@fcsmtp.uams.edu.]