An image of its former self

HIPAA and other regulations steadily are increasing the amount of documentation that must be maintained for each patient. Many industries, in fact, are facing information overload: A 2005 University of California at Berkeley study indicated that roughly 800 MB of new information is generated per worker per year (not taking into account a specific industry), with a 36% annual growth rate.

For the Community Reach Center (a community mental health center) in Denver this translates into 220 GB of information per year. That is an astounding amount of information to track, particularly in an industry required to maintain meticulous records. The Center has improved the management of patient files by implementing an electronic content management (ECM) system.

Overwhelmed by Paper

Before implementing ECM, the Center managed patient information (outside of its overall information system) at six outpatient offices. Patient files were primarily paper and used an extensive coding system.

When Records Department staff received a record request, they would pack the record along with other documents into boxes (weighing between 25 and 40 pounds) and load them into one of four vans used by the Transportation Department primarily for moving clients among offices. An internal certified mail slip, eventually signed by the recipient, would accompany the record. This complex locate, box, ship, and deliver system could take anywhere from three hours for a rush request to as long as two to three days for a normal inquiry.

Records were returned to the original location using the same complex search and ship process. Several hundred records were in circulation in a given week, increasing the risk of loss. With as many as 200 record requests each week and more than half a million documents being managed, the Center was overwhelmed.

At this time we were using a program to capture clinical information online, but we still had paper records related to clients, including documents with nonclinical information, documents requiring signatures, and third- party documentation. And although electronic clinical information was available, many clinicians still would request paper charts.

Electronic Solution

In early 2005, the Center began looking for a system that would eliminate the need to physically store, organize, and ship paper records among its six locations. In addition, the Center wanted an electronic solution that would help with HIPAA compliance.

In May 2005, the Center installed ECM software that converts paper records into electronic images which, along with existing and new electronic files, are stored and managed and are easily retrieved. The ECM system was integrated with the Center's computerized system for tracking each client's clinical and billing information. While in the clinical and billing system, employees can select electronic files and view them instantly. System installation and integration were accomplished in less than one week, and staff training for system administrators and the Center's 175 daily users took three days.

Our paper records go back many years. Our priority was to start electronically archiving records we accessed from June 2005 forward. We scanned loose documents, upcoming intakes, and charts for current and returning clients. The ECM system ties all paper records associated with a client to the electronic health record of a client within the clinical information system. Paper records no longer needed are shredded.

ECM implementation has streamlined the patient care process, as caregivers now have instant access to the information they need directly from their desktop computers. Clinicians can type in keywords in a search function to find associated information and documentation. Instead of waiting days for records to arrive, they can immediately meet their clients’ needs and make fully informed decisions based on clients’ complete medical history.

To ensure HIPAA compliance, the software uses several different layers of security, which can be set based on the user's permission level, the type or class of document, or even the individual document itself, allowing the Center to provide access to information to individuals who require it, while prohibiting access to information not required to complete tasks. In addition, the system provides comprehensive auditing capabilities so the Center can track who is accessing what information and the reason for accessing it.

The table summarizes some of the key benefits the Center has seen using ECM. If you decide to implement ECM, consider if the vendors you are examining offer the following:

• Is front-to-back functionality (scan to retrieve) offered from a single vendor?

• Is the system easy to learn and use?

• Are data stored in a nonproprietary format, making it easy to change vendors?

• Does the software offer flexibility in security and release of information tracking to support compliance with HIPAA regulations?

• What is the vendor's customer support record?

• How long does deployment take, and what impact does it have on resources?

Conclusion

The implementation of the Center's ECM system allowed employees to move patients' medical charts (including progress notes, diagnosis, prescriptions, lab results, dictation, etc.) into an electronic format. The benefits have been numerous. RNs now can view handwritten prescriptions instead of requesting faxed copies. Accounts receivable staff can print financial agreement signatures without leaving their desk or sending a request to the Records Department. By eliminating the physical transportation of medical charts, the ECM reduced the risk of lost or misplaced charts and saved approximately 60 worker productivity hours per month.

Table. Comparing the Center's record management system before and after ECM implementation