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From the October 2003 Issue Converting Interim HIPAA Fixes Into Long-Term Strategies |
Paper-Plagued to Paperless Florida healthcare system now has instant access to patient charts anytime and anywhere it has Internet access. Imaging paper documents can help a healthcare organization reap some of the benefits of an electronic medical record (EMR) without the significant time and financial investments typically involved in EMR implementations. At Gulf Pines Hospital, this approach helped us expand our provider network, make a leap forward in our ability to manage patient charts, save money and improve reimbursement levels. PROBLEM Gulf Pines is one of Florida’s more remote healthcare facilities, operating four rural medical clinics, three home health agencies, an emergency room and a 45-bed inpatient service in Port St. Joe. Already a very busy organization, we faced five-year growth forecasts for a doubling—possibly even a tripling—of the area’s population. Such rapid expansion meant that we needed to find innovative approaches to meet the area’s changing needs. We knew paper was a problem for a variety of reasons, so our goal was to get rid of it—and fast. However, we did not have the budget, time or need to implement a full EMR. At the top of the priority list was making sure we had the necessary physician resources onboard. To encourage physicians to practice at our rural locations, we needed to make it easy for them to view patient charts once they returned to their home bases; this meant giving physicians electronic remote access to patient charts. Without the constraints of physical chart access, Gulf Pines would solve another dilemma: how to find and retain a seasoned coder. At the time, an inexperienced staff person was performing coding, among miscellaneous clerical tasks, but we knew that a seasoned, dedicated coding professional could have a positive impact on our case mix. Electronic chart access and the ability to code remotely would dramatically increase the pool of coders from which to choose. Another, related challenge was the hospital’s paper-based chart management system. If patients hadn’t visited the hospital in 30 days, we had delays in locating their records. In the evenings, charts seemed to disappear mysteriously. The impact on the organization was widespread, from delays in coding and billing to challenges in meeting HIPAA privacy regulations. Storage of paper records was also a problem; files could easily fill two to three rooms of precious hospital space. With off-site storage, we only increased the threat of our records being damaged by the area’s frequent hurricanes. SOLUTION Gulf Pines began evaluating software tools for electronic chart management, carefully considering the cost, implementation time frame, security, training and ease of use associated with each option. The solution we chose was View Manager from San Jose, Calif.-based ChartOne Inc. Paper charts are scanned into a database that is available to authenticated users via a private Internet connection. Multiple users can then access the same chart at the same time, anytime and anywhere. For security, View Manager employs irrefutable logs, digital signatures and RSA encryption, ensuring both HIPAA and JCAHO compliance when it comes to safeguarding and tracking access to protected health information. Gulf Pines determines which users can access the system and controls the access centrally. ChartOne does not require an upfront capital outlay for equipment, since it provides all of the technology infrastructure—including system backup—and guarantees 24/7 support. Gulf Pines pays a monthly fee to use View Manager. We also felt confident that we would be able to make the transition from paper to electronic documents in six months. IMPLEMENTATION We launched an intensive effort to image all of our existing charts, with ChartOne supplying document imaging services through its facility in Plano, Texas. Within four weeks of selecting View Manager, our first patient charts were online. Our staff was fully trained in two days. ChartOne staff remained for another two days to ensure a smooth transition. Now, Gulf Pines scans patient charts into the system as soon as new charts are completed or old ones are requested. When it came to using View Manager, ChartOne trained our director of health information management (HIM), who in turn was responsible for training the rest of the HIM staff as well as physicians. The HIM director acted more as a resource than a trainer; most people taught themselves how to use the browser interface with very little or no instruction. The entire implementation process, including the transition to in-house scanning, took about four months—two months under our goal. RESULTS First is the impact on patient care. When a patient arrives in the emergency room confused and distressed, staff can enter the patient’s name into the system and pull up his or her chart. If the chart happens to be in utilization review or elsewhere in the hospital, the chart is still available to those providing care. In addition, because the information can be sorted and viewed for lab tests, radiology visits, physical examinations, medications or other preferences, staff get a clearer view of the patient’s status more quickly than paging through a paper chart. For functions such as utilization review, risk management and quality assurance, the ability to easily pull specific data from a chart is a tremendous timesaver. In accounts receivable, staff can print relevant parts of the record along with the bill to the insurance companies, often anticipating needs before they arise. Charges are reimbursed faster, with fewer denials, and missed charges can be spotted and more easily collected from payers. In addition, remote access to patient charts has allowed Gulf Pines to retain one of the most experienced coders in Florida. As a result, our case mix has steadily increased, and we are billing on average anywhere from $500 to $1,000 more per claim. There are no lost diagnosis related group code sets, the ambulatory payment classifications are accurate and we are confident that our coding is done correctly the first time. With our medical records online, we have been able to free up at least two rooms in the hospital, and we have reduced the number of full-time employees handling medical records from three to a single person. The savings attributable to these reductions in physical space and payroll is about $5,000 per month. When the impact of our coding improvements is factored, I estimate the total financial impact on Gulf Pines of implementing View Manager is about $10,000 per month. Finally, our ability to minimize the traveling that physicians have to do by giving them remote access to patient charts gives Gulf Pines a reputation for being more technologically advanced than the hospitals in Panama City, the nearest metropolitan area. In turn, we have gained a competitive advantage in attracting some of the best cardiologists and other physician specialties to practice at our facilities, helping us to achieve our goal of being a model healthcare provider in rural Florida. SOURCE Hubert Steeley PRODUCT/COMPANY
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