A Final Farewell to Paper

Aug. 1, 2006

Document management system exceeds expectations for administrative efficiencies, profitability and ROI.

As any practice administrator can attest, when patient paper charts are incomplete, misfiled or “missing,” resulting delays are time consuming, frustrating and costly. In 2005, University Dermatologists Inc. solved that problem; it bid farewell to paper-based charts.

Document management system exceeds expectations for administrative efficiencies, profitability and ROI.

As any practice administrator can attest, when patient paper charts are incomplete, misfiled or “missing,” resulting delays are time consuming, frustrating and costly. In 2005, University Dermatologists Inc. solved that problem; it bid farewell to paper-based charts.

Problem
University Dermatologists operates seven offices within a 35-mile radius of Cleveland, Ohio. The practice includes 11 dermatologists, one dermatopathologist and more than 55 nurses, administrative and practice management professionals—a total of 140 hands shuffling 70,000+ paper-based medical charts for 50,000+ annual patient visits.

Our patients prefer to be seen by the same doctor and will travel to a different office to maintain this consistency, creating a special challenge for a paper-based system. One of our physicians sees patients in four of our office locations, while the other 11 doctors rotate among three sites during the week. Two physicians travel from one site to another in the same day.

Each day, we faced a logistical nightmare in coordinating chart availability and ensuring that each patient’s chart was at the right office at the right time. Too often, we had multiple charts in different offices for patients, none of them complete. All charts risked being lost in transit or misplaced upon arrival.

Solution
Beginning in 2004, we spent a year evaluating our options. One of the deterrents to adopting an electronic health record (EHR) was that it would require the doctors to perform data entry, a negative since the doctors regard themselves as scientists and did not want to be slowed down by keying. This reticence to change their practice styles extended to our investigation into a voice-activated EHR, with our doctors concluding that they would not be comfortable dictating notes in front of patients.

The practice’s senior management team decided to explore a document management system and successfully identified one that met our requirements to digitize patient records without disrupting the way our physicians practice medicine. At the American Academy of Dermatology annual meeting in San Francisco, we learned about SRS Software, developer and marketer of the Freedom Chart Manager, and this took us in the right direction.

Freedom Chart Manager did not require our physicians to change their practice style. This resolved the practice’s paper chart woes and, at the same time, retained the “familiarity” of doctors’ practice styles. The software offers a system of digitized patient records including all handwritten chart notes, patient registration forms, superbills, insurance cards, lab reports and correspondence.

All documents appear in reverse chronological order with the newest on top and older ones behind. Any paper generated from patient encounters is placed in a “To Scan” pile and added to the existing scanned chart via a high-speed scanner. All paper documents received from outside sources following a patient visit (e.g., letters, lab results) are scanned into the patients’ digital charts, too. Any part of a patient chart can be faxed or printed directly from the computer screen. Pictures can be scanned or imported digitally into a chart in a few seconds, and X-rays and slides can be scanned in with transparency scans. Also, the system creates “e-drawers” which allow us to electronically file documents such as EOBs and invoices, and keeps them separate from patient chart documents. Purging or archiving charts is unnecessary since storage space is virtually limitless.

Our Freedom Chart Manager database resides in four places: on the server; copied to a backup server; on the doctors’ laptops (a brief case of the day’s charts); and on a digital backup tape. The backup tape is periodically removed from our office and kept offsite to protect our charts against fire, theft, flood or a similar disaster. All workstations are password protected.

Each exam room has a computer, as do the reception, billing and tech areas. Freedom Chart Manager runs on any Windows computer on Windows NT, Windows 2000, Novell or UNIX networks, with workstations running at 300MHz or faster with 128 megabytes of RAM. In the administrative staff area, we use high-speed scanners, which scan 30 pages per minute (60 pages per minute on both sides). We can also scan hard plastic insurance cards and color photos. Installation of the scanners is included in the SRS software price, and their staff worked with our data networking company to create a high-speed private network among our seven offices using point-to-point T1 lines.

Implementation/Training
Embracing change is not easy. Several of our doctors were very vocal in opposition to the new system. They were worried that document management would slow them down, disrupting their normal patient volume. They were also afraid that a new system would impede their collective abilities to see the same number of patients as they had previously. But, they visited firsthand fellow dermatologists’ offices in the New York area to see the SRS solution in action; it was the site visits that quelled their concerns and answered their questions on how the process would unfold. By the summer of 2005, the entire physician team and staff alike were committed to document management—and at our practice retreat, six months into implementation, there were no nay-sayers to be found.

Successful implementation of any new technology requires extensive planning. I believe that the reason we encountered no implementation difficulties was that we worked diligently on a well-choreographed roll out.

In the spring of 2005, Freedom Chart Manager was installed at all our office locations, and an SRS implementation specialist visited the offices to train the intern staff. During the summer, closer to our go-live date, the SRS specialist returned to train the physicians and office staff. Sometimes the trainer worked with us in a group setting and, on other occasions, on a one-to-one basis. Doctors and staff, while at slightly different PC/mouse proficiency levels, were all very comfortable using both the PC and the mouse before we started the implementation.

Total training time at each site was about 45 minutes for physicians and two hours for other staff members (who learned bar coding as well as scanning processes.)

By April 2005, our office receptionists started the pre-sorting process, which lasted until July 5, sorting charts and time-stamping them to establish an orderly system. The goal was to scan into the new system all active charts from the past three years—70,000 charts—including all progress notes, entire biopsy notes as well as all surgeries.

We hired six part-time interns from July 5 to August 15 to help with chart bar coding and scanning. Bar coding indexes the volumes of paper documents generated by patient visits to the appropriate electronic charts and the proper placement within those charts in a matter of seconds, processing about 600 documents per minute. There was no disruption to the medical practice, either for the physicians or the patients, because some interns worked after hours in the evenings. This segment of the scanning process began on July 5 with a scheduled go-live date of September 6, 2005, the day after Labor Day.

From July 15 to August 15, 20 percent of our charts were scanned into the system. We determined that after August 15, charts would be scanned in on an as-needed basis before each patient appointment, with a planned incremental roll out of one office site at a time. The SRS specialist returned right before our go-live to reinforce the training and to be available for last-minute questions. All office sites successfully went live within one week.

Five part-time interns continued the bar coding and chart scanning regimen from August 15 until the end of January 2006. At that time, a total of 70,000 charts were scanned into the system.

Results
Freedom Chart Manager also gave us desirable workflow options such as messaging, electronic prescriptions, flow sheeting, and order entry and management. For example, instead of going through the tedious process of pulling paper charts, attaching biopsies, having doctors approve them and finally signing off, only to file again, a process which ordinarily took days, the system allows the doctor to review everything electronically at a computer in the office or a remote location and complete the entire task in a few minutes.

Allocation of staff time changed with the implementation, too. It used to take one file person, as well as a nurse, just to handle incoming phone messages. Now it takes only one nurse to handle 35 to 40 phone messages with biopsies and prescription results each day.

Today, we waste not even one minute playing phone tag with the doctors at the various office sites. Instead of several calls to each physician daily, personnel put their messages on the SRS system. Our doctors have SRS on their laptops and can send messages back and forth even on weekends or if they are out of town. Generally, our physicians check their messages three times per day and within four hours or less, they respond—even if they are at the hospital or at home.

The system has saved us labor costs. Less than six months post-implementation, we released three part-time file clerks, each working 22 hours per week. Salary and benefits represent a recurring savings of almost $34,320 for our practice.

This ROI was further enhanced through redeployment of existing staff. With our old traditional paper chart system, front desk personnel at each of our practice locations were always involved in searching for charts. Before the SRS implementation, one office site had five full-time receptionists. Now, because patient volume at two of our offices has grown approximately 30 percent and 50 percent respectively, two of those receptionists split their time between those sites, which formerly had only one receptionist per office. We would have had to hire at least 1.3 additional FTEs to manage the increased patient volume in those locations, but since we transferred people into those areas, no additional hiring was necessary. Salary and benefits represent a recurring savings of $60,170.

In January 2006, we opened our seventh office location. Ordinarily, our plans would have entailed space for a patient chart room, but because we now have a paperless document management system in place, there was no need. At $30 per square foot, using one less room represents a yearly savings of $1,500 rental costs plus the monies for mobile chart shelving at a cost of $3,265. Our other six locations have more space now that the charts are gone, too. We plan to reallocate the chart room space as employee rest/lunch areas at some office locations and as a conference room for staff at another site.

With electronic versions of all our forms, paper and printing costs have dropped, along with the number of faxes, since we no longer have to fax documents between offices. Our printing costs are down 60 percent since we only print letterhead, appointment cards plus some brochures, for an estimated annual savings of $9,000. Savings on chart costs and supplies represent an additional $9,000 per year for all our office locations. And, since we no longer have to transport hard copy documents from office to office, our courier costs have been reduced by 75 percent, an additional $8,000 annual savings.

Another impressive statistic is zero, representing the number of lost charts we now experience. The system has the full support of all physicians and staff, including those who initially voiced concerns. Even patients have noticed the new electronic system, recognizing that our established practice is moving forward technologically.

For more information about Freedom Chart Manager from SRS Software, www.rsleads.com/608ht-202

August 2006

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