On a mission to eradicate paper

Jim Bowden is on a mission to round up and digitize every paper document related to patient care at Palisades Medical Center in North Bergen, N.J., as the hospital embarks on an electronic medical records (EMR) installation in the next 18 months. Before Palisades goes live with its Siemens Soarian EMR system, Bowden, Palisades' director of patient financial services, is having his team transfer all patient billing information into a document management system. He knows that, for many organizations, such a system can be a transitional bridge to EMR implementation.

Palisades runs a 202-bed hospital and a 245-bed nursing home and rehabilitation center. The state's annual healthcare report card ranks Palisades Medical Center as one of the top hospitals in New Jersey and number one in Hudson County. Its nursing home, The Harborage at Palisades, has “zero deficiencies” — a result that is earned by only 3 percent of nursing homes in the U.S.

When Bowden took his post at Palisades in 2008, he was determined to earn the same stellar ranking for the Palisades business office and patient admissions. Accountable for Palisades' business office operations and a 38-year healthcare management veteran, Bowden set out to automate all patient records.

Patient information comprised of pre-admission documents brought in by the patient plus hospital-generated forms were copied, maintained in paper folders and then stored in filing cabinets throughout the hospital campus. Storage rooms on-site and rented facilities off-site housed thousands more historical records at a costly fee.

Paper and financial woes

Treating approximately 160,000 patients annually, Palisades billing clerks were copying an average of 20 paper documents per patient. This did not include the patient's 40-plus electronic forms and images stored on servers and the continuous need to retrieve patient files for billing discrepancies.

As a result, Palisades Medical Center was accumulating millions of paper documents each year and spending a great deal of time trying to find the documents that were stored either on-site or in the off-site warehouse.
In addition, the business office was handling patients who would deny their identity after receiving their hospital bill.

When it rains, it pours

Shortly before Bowden arrived at Palisades Medical Center, the hospital experienced a flood. Most patient billing records, which were only in paper form, were wiped out. Less than three years later (March 2009), the hospital experienced a second flood, just three months after going live with the RAS imaging and document management system from DB Technology. While the process of electronically scanning patient records had already begun, nearly 200 boxes of paper records had to be freeze-dried to recover patient data, costing the hospital approximately $20,000.

“This experience could have been a lot worse if it weren't for the scanning project,” recalls Bowden.

The “paper automation” strategy

The first step toward overhauling patient billing operations was to identify all the issues Bowden's staff experienced during patient registration, then developing the electronic workflows using the document management system to guide billers and clerks through the patient registration process.

A document management system would show the staff what paperwork (prescriptions, orders, referrals, authorizations, etc.) and insurance information was to be provided at the time of registration and it would take a picture of patients while they were sitting in front of admission clerks. This would eliminate the patient returning months later and denying that they had received the services that they were billed for.

Bowden had used a document management system at a previous hospital and was able to convince administrators that this technology was the best way to cut paper overload, streamline patient information, protect against disasters, shore up workflow processes and capture lost revenues. His initial goal was to convert every paper document to digital form, starting with patient accounting records.

Palisades Medical Center chose RAS because the software was proven effective at other well-respected hospitals in the region, including Hackensack Hospital and St. Barnabas. RAS also had more flexibility and was far less expensive than competing products.

“The RAS imaging system took us less than three months to install without requiring any custom programming or IT involvement, which was a big selling point,” says Bowden.

According to Bowden, RAS gave him a true enterprise resource with multiple functions and workflow capabilities. RAS captures, compresses and archives all scanned paper and electronic patient documents into a searchable database, which allows users access to real-time, ad-hoc and archived information in report form.

At Palisades Medical Center, RAS consolidates patient data into a centralized database for processing, workflow and archiving. Authorized users can access reports or submit individual patient queries to the system. RAS also stores hundreds of admissions/discharge/transfer reports generated by Siemens' Invision, Palisades hospital information system (HIS), and makes them accessible with a user ID and password, or pushes reports to recipients through e-mail.

Mission to eradicate paper a success so far

Now RAS manages all patient admission and registration forms for a variety of departments, including emergency, outpatient, inpatient, wound care, mental health and the sleep center. This includes any paper documents the patient brings to the hospital upon registering, such as a driver's license, insurance card, drug prescriptions, physician referral forms, consent and release forms, etc.

“We now collect and scan all patient information, and it's managed in one central place,” says Bowden. “If one of our clerks copies down the wrong insurance card number, they can go back to RAS and get the correct ID number. Using RAS, it now takes less than 30 seconds to find the information needed.”

As the patient goes through clinical treatment, services are coded and bills are dropped by Invision and circulated through the billing office for insurance eligibility review.

“If we need to look up eligibility, we can go back to RAS to check the electronic patient folder for insurance coverage and make the necessary changes,” says Bowden.

A separate process is required for the 15,000-plus patients who apply for financial assistance each year. The paper charity-care forms plus all non-clinical patient information are now stored in RAS.

Also with an average of 35 out of 100 bills being initially denied by HMO and commercial payers or delayed in the payment process by the insurance carriers each month, RAS-based patient registration information provides easy proof that a specific treatment is covered.

Due to the fact that all paperwork for the patient's episode is indexed in Palisades's computer system, it is very easy to determine what the situation was when the patient walked in the door. Did the patient provide the correct insurance information? Did the clerks obtain a pre-cert? What were they told by the person on the other end of the phone? Also, photos of each patient are now taken at the point of registration and stored within electronic patient documents using RAS.

“If we have a picture of the patient we serviced, that patient cannot deny his or her identity,” says Bowden. “Sometimes, the patient even admits to us that they know the person in the picture. That leads to a very interesting conversation!”

Document management's future at Palisades Medical Center

By early 2011, all 64 patient registration and clinical forms will have bar codes to identify patients' medical records, patient account numbers and form numbers (for indexing purposes). This will allow billers to scan a stack of documents in no particular order, and RAS will direct documents to the proper electronic patient folders. Also by year's end, all managed care contracts will be accessible through RAS.

This year, Bowden and his team plan to scale RAS to manage non-patient information, including administrative management contracts, purchasing, shipping and receiving, vendor accounts payable and possibly payroll and human resource department functions.

Most importantly, Bowden foresees RAS being an integral part of Palisades' overall goal to have complete electronic medical records. “No matter how technologically advanced our EMR system is, there will always be paper copies of documents that will need to be combined with the system,” he says.

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