Scanning initiative takes Arizona facility a giant step closer to EMR
Access staff clear almost 9 million pages from basement storage
An ambitious scanning project at Mt. Graham Regional Medical Center in Safford, AZ, has turned "mountains and mountains of paper" into easily accessible electronic medical records, consent forms, and financial documents. Already complete — ahead of schedule and using fewer resources than expected — is the transfer of almost 9 million pages of medical records into electronic format, says Julie Johnson, CHAM, director of health information management, access, and customer service for the rural, not-for-profit, 59-bed facility, which serves patients within a 100-mile radius.
The project, which started in the registration area and will encompass the entire facility, "will solve our storage problem and move us toward an electronic medical record," she adds. "We’re about 75% there."
Part of Mt. Graham’s mission statement is about "combining technology with compassion," Johnson notes, which helps explain why the small hospital has tools such as state-of-the-art magnetic resonance imaging (MRI) equipment and the latest ultrasound for viewing unborn babies in 3-D.
CEO Pat O’Brien sets the organization’s pro-technology tone, she says, with the focus on "providing whatever we can to our community."
With that in mind, Johnson explains, the hospital invested in some heavy-duty scanning equipment — purchasing two scanners at a cost of $25,000 each — and hired five temporary employees, ultimately finishing what was expected to be a one-year project in about five months.
After completing that first phase at the end of November 2004, "we’re moving on to patient accounting where we’ll scan EOBs [explanation of benefits] and other financial documents," she says. Next on the list is the human resources department, where physician credentialing and employee hire packets will be scanned, and then the home health program, which has its records on a different database.
Johnson says she believes the entire project — now slated to take five years — actually will be completed in about three years. Savings realized from the project — including what would have been paid out in wages and other expenses five years into the future — are expected to be at least $156,000, she estimates, which doesn’t include rent and security service costs.
Meanwhile, Johnson adds, staff no longer have to go to a storage area that is located two miles away in the basement of another building and retrieve a medical record in the middle of the night when a physician needs to know a patient’s past history and medications. "One of the most exciting things was the first time we actually got to experience retrieving a record online instead of going down there," she says. "We had a couple of people come in right after [installation]. The record came up clear and concise, and we were able to print what they wanted. We [all said], It works!’" Johnson notes.
In the registration area, employees now scan patients’ driver’s licenses, insurance cards, and physician orders into the computer, eliminating those paper files, she says.
By September 2005, patients will sign electronic conditions of admission and conditions of treatment forms — anything they have to sign — and those signatures will automatically populate the forms in the same way many retail customers sign for a credit card purchase.
Scanning the millions of pages of medical records into the system was a more daunting task, Johnson says, and in the beginning there was "lots of trial and error."
Initially, "we thought we were doing well when we were [scanning] 500 pages a day per person per shift," she explains. Soon it became clear that splitting the task — having one shift prepare the documents and the next do the actual scanning — was more effective, Johnson notes. "Then we were doing 7,000 pages, which we thought was excellent."
After the addition of the second scanner, she says, "We were able to shift gears and do 15,000 pages per person per shift. That’s what we had to do to complete the project, to scan in almost 9 million pages. Some of those were two-sided, or fold-out, which could mean four scans."
The pace picked up even more when some healthy competition was added to the mix, says Johnson. "We had incentives — who could scan the most and who could be the most accurate," she adds. "Our medical records and admitting departments had a contest, and we picked a scanner of the week. We even had shredding contests."
Winners were rewarded with movie tickets, soda, and pizza, Johnson notes.
The overall directive, she points out, was that nothing could be lost, and accuracy was paramount. Even though "it is unheard of for two servers to ever go down at once," Johnson continues, Mt. Graham has two servers on-site and another off-site. "It’s pretty expensive, but we are dealing with a patient medical record that we are charged with keeping [secure]," she says. "We’re getting close to a full transition to electronic medical records, and we have to have something in place that everybody feels comfortable with."
Preventing clutter
To keep the paper clutter from creeping back in, Johnson notes, more scanning will be done up front. In addition to the immediate scanning of driver’s licenses and consents, and the upcoming electronic signature in the registration area, she says, when it comes time to purge a patient’s chart from the main file and send it to storage, medical records employees will scan the chart right away, so there will be nothing at all in off-site storage.
After EOB documents are scanned into the computer system in the next phase of the project, Johnson adds, a scanner will be left in the finance area so that employees may continue to scan documents.
"If [a patient] calls about a bill, the employee won’t have to go to a file, go through 100 to 200 EOBs by date in a folder, find one, and go talk to the patient," she says. "Instead, the EOB document will be immediately available on-line."
Mt. Graham is working with two vendors on the scanning and archiving project, Johnson says. "[Rochester Hills, MI-based] Cypress Corp. has the patent on compression for storage, and [Malvern, PA-based] IKON has the indexing [piece], which is the software to tell the scanner what to do."
During the process, she adds, Cypress interfaces with the hospital’s health information system, a product of Mobile, AL-based CPSI, which specializes in working with small hospitals. With the Cypress system, Johnson notes, documents may be stored electronically for whatever length of time is desired.
Johnson learned from experience that making sure the document has been properly scanned and recorded needs to be a separate piece of the process. After a month of being very worried about that issue, she says, the hospital sought assistance from IKON. "The person who scans has to verify and view, but it took a while to figure out how we wanted to verify," Johnson adds. "If we verified every page, and the medical record had 300 pages, we never would have finished."
"We set up checkpoints after every batch scanned. With every single document, we checked the face sheet and then did a random check of other pages."
Another way of verifying, she points out, is to have the pages flash up on the screen, and check them as they go by.
Ivon Hansen, who worked as scanning supervisor during the project, says she was amazed at how sophisticated the scanner is, especially in the area of document preparation. "It would let us know as we went if more than one page got scanned at the same time," she continues. "It would stop and alert us."
"You don’t need a lot of people around the scanner," Hansen adds. "You feed it and it does its job."
[Editor’s note: Julie Johnson can be reached at (928) 348-4027 or by e-mail at [email protected]. One of the vendors mentioned in this story, Cypress Corp., was acquired by Naples, FL-based ASG, an enterprise software and professional services provider, in late March 2005.]
An ambitious scanning project at Mt. Graham Regional Medical Center in Safford, AZ, has turned mountains and mountains of paper into easily accessible electronic medical records, consent forms, and financial documents.
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