Effectively delivering applications in healthcare means connecting people with processes and information — bridging the information gap. One of the major considerations in doing this is how those applications reach people. Healthcare organizations may have different challenges when it comes to collecting, securing and managing information, but nearly every provider begins these business processes with data capture. The challenge lies in how to capture information securely and accurately, while providing the easiest and most flexible experience for users.

Securely and efficiently improving human-centric, information-intensive processes such as medication reconciliation and patient registration requires an integrated server solution that blends data capture, information assurance, document output, process management and content services. Robust applications that reduce paperwork, accelerate decision-making, ensure regulatory compliance and improve information accuracy are available for physician practices and hospital systems of any scale. As Birmingham, Ala.-based St. Vincent’s Health System discovered, the goals of paperless workflow and automated document management are well within reach.

A Role Model Innovator

St. Vincent’s Health System is part of Ascension Health, the nation’s largest Catholic and non-profit health system, and consists of five facilities in and around the Birmingham, Ala. metropolitan area: St. Vincent’s Birmingham, St. Vincent’s Blount, St. Vincent’s East, St. Vincent’s St. Clair and St. Vincent’s One Nineteen Health and Wellness. In 2003, the provider’s primary hospital (St. Vincent’s Birmingham) saw approximately 125,000 outpatient visits, 17,000 inpatient visits and more than 28,000 patients in its emergency department (ED).

According to Steve Anderson, director for St. Vincent’s Health System/Ascension Health Information Systems, the hospital has always been at the forefront of healthcare technology adoption including an electronic clinical documentation system to support patient charting, electronic medical records (EMR), bar-code scanning of patient medications, as well as a wireless network infrastructure. He says the hospital began identifying gaps regarding utilizing the data delivery capabilities of its EMR, and in 2003, a search began for a solution to automate dozens of patient admissions forms and patient consent forms.

Objectives

St. Vincent’s expected the solution to enable its staff to better manage these forms, in addition to providing: improved compliance and confidentiality; improved patient services by minimizing the time patients spent on completing forms; reduced liability due to higher levels of information accuracy; and, reduced operating costs through streamlined collection and storage of form data to a central document repository. In early 2003, St. Vincent’s evaluated several electronic forms solutions among a range of vendors, before deciding to standardize on Adobe software with the Adobe Electronic Workflow product line.

Mike Totty, IT manager for St. Vincent’s Health System/Ascension Health Information Systems, says their goal was to improve several patient-interactive and general business processes. This would move the hospital closer to its goals of minimizing paper use and replacing all paper-based processes in the health system with electronic workflows. “We wanted to bring a paperless patient registration process to Admitting,” says Totty. “The pilot was rolled-out in January 2004 and included automatic generation of electronic consents, HIPAA privacy notices and various insurance-related documents.” Both patients and staff members were extremely pleased with the experience and added functionality of the new software, Totty says, but due to HIPAA concerns, as well as capital constraints, it didn’t see full implementation.

Later that year, the hospital replaced its existing patient information management system with McKesson STAR, an Admissions, Discharges and Transfers system. Patient demographics, insurance and billing information is entered and stored using STAR and Physician Portal, a Vignette platform-based interface physicians use to view clinical information about a patient.

“This included using our Adobe software to generate armbands, labels and face sheets for every patient we touched,” says Totty. “Our application is integrated with STAR and with the EMR repository. This has been an ongoing process in production since August 2004.” Adding to STAR, the hospital’s IT team built additional functionality (JSPs and scripts) for exporting patient data in XML format. They have worked since 2003 to integrate back office forms generation and print functionality with STAR as well.

Results

In 2006, St. Vincent’s IT group implemented Adobe LiveCycle, helping them transform paper-based medication reconciliation processes into a fully integrated clinical electronic workflow. It provides hospital staff with data from clinical and pharmacy systems, creates PDFs for presentation and allows clinicians to make patient care decisions and automatically print them at a nearby printer. Totty says they are currently enhancing the workflow to electronically send orders to the pharmacy system and route them to the EMR. “In 2007, we spent much of the year migrating applications to the new version, LiveCycle 8,” says Totty.

With the new document management solution, the hospital automated generation of common patient-identification materials for as many as 60,000 patients annually, including outpatients, inpatients and ED patients. “Upon patient registration, a file is delivered from STAR to the Adobe LiveCycle Process Management server, which parses the information to specified printers to automatically generate armbands, labels and face sheets. Documents also flow into their Sovera document imaging system, a component of St. Vincent’s EMR. “If nurses or other clinicians need additional armbands during the course of patient care, they can print the material on-demand,” says Totty. “That has reduced costs, initially by eliminating key plates and the different kinds of armbands, so we’ve reduced costs substantially.” He estimates the cost reductions from $30,000 to $40,000 annually.

“We also made modifications that allow us to save additional expenses on the paper stock we use,” Totty says. “We’ve eliminated the need to print the armband on a laser band sheet, and are just using the labels now.” They haven’t rolled it out to the small rural hospitals yet, but once they do, he says they expect to see greater savings.

The original key plates, which resembled credit cards, were used for each patient and required a labor-intensive process of document scanning. “Then we went to bar-coded labels and armbands and saw a $10,000 to $15,000 annual savings,” says Anderson.

An additional efficiency gain to their document management processes, Anderson says, is that they’re now only scanning documents upon patient discharge.

“The bulk of paper-based data during the patient’s stay remain in paper form for that whole period of time. That means you must be in their room looking at the chart to see the data. As we convert that data into electronic form it becomes available via Physician Portal, for clinicians to utilize in the care of the patient. This creates many significant workflow efficiencies, from that perspective, that directly benefit our patients,” says Anderson.

Physicians select a patient and instantly view data such as radiology, labs, pharmacy and other patient care information, and reports listing patient medications are generated automatically. When a physician reconciles the patient’s medication, LiveCycle pulls data from the clinical data repository and merges it with a PDF form for display. Using the compiled report in PDF, the physician can review each medication, add instructions and order new medications from the pharmacy.

Physicians complete orders to the organization’s pharmacy with the product’s medication reconciliation
application as part of the reconciliation process. Physicians use the online physician ordering system to enter almost all orders into the hospital’s system. It also generates a prescription form with 2D bar codes that pharmacists scan to capture relevant patient information.

After entering all the patient information, the HIS delivers a flat file, which IT converts into XML with some custom coding before passing it to LiveCycle. A pilot of LiveCycle Forms, planned for next year, will have the application parsing this data into the appropriate registration forms and delivering pre-populated forms to clerks to review with patients. Using Adobe Reader, clerks will make any last-minute changes to forms before patients electronically sign them using CIC Sign-it technology. Completed registration forms will then save to the document imaging system.

For patients and registration clerks alike, traditional paper-based registration processes are time consuming and potentially error-prone. By integrating the system with its HIS, the hospital has significantly streamlined these processes and greatly improved data accuracy.

Looking Forward

“We’re still working towards the paperless hospital,” says Totty. “With these new systems, we’re getting closer. For an organization to accomplish its goals, requires a sharply-focused vision of what it wants to accomplish and where it wants to take it,” he says. “You’ve got to plan carefully, be very realistic about timelines and don’t try to do more than you need.”

“We’re certainly happy with LiveCycle 8 and we’re excited about the new applications for it that are enabling us to do more in less time,” says Anderson. “I feel like we have the tools now to reduce our paper use and make those documents available during patient care, while also reducing documents requiring signatures or annotations. So I think it’s the right tool for the job and we’re excited to have it in our organization.”