ECM Elevates Hospital's Documentation Capabilities

By Amanda Griffith, Contributing Writer

A new ECM solution helped Skagit Valley Hospital consolidate important document images and facilitate access, improving staff productivity.

The enormous number of terms associated with electronic content management (ECM) — electronic document management (EDM), business process management (BPM), case management, imaging, records management, full text indexing — can leave a hospital’s staff feeling bewildered. When Skagit Valley Hospital, a general medical and surgical hospital in Mount Vernon, WA, just north of Seattle, set out to replace its legacy document management system, it set several project goals as it worked to develop and implement a new ECM system. Must-have functionality included improved dependability, increased capabilities, increased automation, reduced manual intervention, and added-color document archiving.

The hospital, licensed for 137 beds and offering a full range of surgical services, advanced diagnostics (e.g., CT, MRI, PET), and a center for sleep disorders, had an eight-year-old ECM system that lagged behind current medical and technological needs. Not only did it lack capabilities like electronic integration and full-color document archiving, it used outdated hardware and software no longer supported by its vendors. The hospital also suffered from backup storage media issues, making it expensive and difficult to convert images from paper to digital.

Alan Duke, PMP, OCSA, clinical systems administrator at Skagit Valley Hospital, conducted a competitive analysis of two very different ECM systems during his search to replace the outdated system. One represented an established vendor relationship, though it came at a higher cost and lacked features that staff currently used, such as pharmacy scanning for immediate billing and scanned remits. The other offered its solution at a lower cost and with the ability to convert files in-house.

“When we looked at OnBase by Hyland Software, which had by that time acquired Valco Data Systems, we were impressed by its ready integration with other systems such as RightFax, as well as its long experience with scanning and archiving,” said Duke.

An Implementation Plagued With Challenges
At the time Skagit Valley Hospital began its project, extensive flooding in Thailand closed Western Digital Hard Drive plants where 25 percent of the world’s supply is made. This delayed the delivery of HP servers, which threatened to shift the ECM implementation schedule indefinitely. Last-minute efforts by the server team, however, enabled the hospital to use assets ordered for another project so it could meet its deadline.

With that hurdle overcome, Duke and his team worked with the vendor to design the system and make recommendations for greater efficiency and began to convert files. Unfortunately, more problems lay ahead. The server/jukebox the hospital was using crashed two weeks before go-live while in the process of backing up and converting files.

“We lost access to many document images normally stored on the server for immediate retrieval,” Duke recalled. “We had to restore the missing document images from off-site backup media, but we couldn’t accomplish this via the old jukebox because it was no longer operational. When troubleshooting and repair efforts failed, we turned to another solution.”

After renting a jukebox and server with the help of KOM Networks in Ontario, Canada, Skagit Valley Hospital’s implementation efforts resumed; even though the jukebox fell off a truck on the way to Seattle, it continued to work, despite its external damage. While there is no comparable data for the legacy system, the hospital estimates from the number of document images recovered during the recovery/importation process performed by KOM, almost 14 million files in 18,751 folders.

“We recovered more than one million documents without losing a single one, thanks to the tireless efforts of our vendors whose staff worked through the night 24/7 for weeks on end to import documents and get everything up and running,” said Duke. “We even completed our implementation and went live with OnBase 11.0 one day early.”

Improved Scanning, Indexing, OCR Streamline Hospital Processes
The OnBase conversion project began on Jan. 1, 2012, and went live on Aug. 1, 2012. Since then, staff members have imported and scanned a total of 220,000 documents and an estimated 15,000 color images ranging from color reports to high-resolution color OR, ENDO (endometriosis), and wound clinic photos. The new ECM system also enabled the hospital to continue using its current input hardware, including scanners, signature pads, and clipboards.

The new scanning and indexing process is more user-friendly than the legacy system and would be faster but for the addition of the required quality assurance (QA) process which, with the improved reporting capabilities, makes it easier to detect errors and correct them. The legacy system required using individual applications for scanning, batch management, and indexing. The ability to import documents into the new system, rather than just scanning into the legacy system, resulted in improved speed and efficiency and better quality images.

“Business office productivity has also improved due to the ability to use optical character recognition (OCR) on all imported text, allowing free text searching through any of the hospital’s almost 20,000 batches processed since August 2012,” added Duke.

The hospital also introduced front office scanning to more registration areas, including diagnostic imaging and lab, and it developed a process for importing images of sterile instrument sets received from vendors to document quantity and condition of sets.

Next Step: Tighter Integration With The EMR
Now in the process of upgrading to OnBase 13 (the hospital skipped Version 12), Duke and his team also plan to implement the Medical Records Module, which will enable e-signing of scanned and imported documents resulting in quicker turnaround of scanned documents in the EMR. Currently, a record cannot be scanned into the ECM system until all physician signatures are obtained and the record is complete. This delays the availability of the scanned documents to clinical staff, coders, and QA personnel and burdens the HIM clerks with handling the records multiple times reducing efficiency. With the ability for physicians to sign scanned documents from anywhere and for the HIM staff to better manage deficiencies within the ECM system, the entire organization will reap the benefits.

Throughout this challenging implementation, the hospital staff learned many lessons, such as the importance of a critical system replacement cycle and decentralized storage as well as how to deploy more fault-tolerant systems. It’s now wary of proprietary storage media and practices downtime and disaster recovery, knowing that it’s necessary to plan for emergencies as “when,” not “if.” Most importantly, the hospital learned the value of investing in human capital.

Considering that 60 percent of an employee’s day is spent working in some way with records and documents, according to a report by consultant firm the Delphi Group, one can see how efficiently managing that information — physical and electronic — can determine the success or failure of any organization. By implementing a smart document management solution, Skagit Valley Hospital consolidated all of its core document-centric information into one place, stored electronically, which then makes it much easier for users to find the documents they need. This enables clinical staff to focus on what matters most: providing the best care possible for patients.