Removing the 'Shadow' from Electronic Medical Records

Electronic Medical Records (EMRs) are one of the most promising developments in medical cost control, patient care and patient privacy. Ironically, their inability to eliminate the need for supplemental paper charts -- until now -- has been one reason less than five percent of physicians use them.

Like paper charts, EMRs contain a wide range of information on an individual patient, including current diagnosis and prescriptions, drug allergies, and medical history.

Handwritten clinical charts are expensive to store, error prone and slow to retrieve. Before your doctor sees you, a chart must be located and pulled from a local or offsite location then delivered in time for your appointment.

Unfortunately a recent study found that 27 percent of patient charts aren't available for patient appointments. That means your physician does not have your medical history or treatment regiment available when he sees you and information from the visit will have to be entered into your chart later -- if ever.

EMR systems present a patient's record whenever it's needed through access terminals in exam rooms and offices or wireless handheld devices. These systems eliminate lost charts, unreadable handwritten notes and the substantial cost of storing, maintaining and accessing them.

The Problem

An EMR system cannot eliminate paper on its own. That's because its electronic database software has no ability to convert paper documents into a compatible electronic format. Unfortunately, lab test results, such as EKGs and spirographs, consultation letters, release forms and other external documents arrive at a clinic as hard copies. Until recently, these vital patient records had to remain on paper -- a "shadow" system which complicated operations and compromised the benefits of the EMR.

That was the situation at The Oregon Clinic, a 65-doctor, 400-employee, 11-office medical specialty practice in Portland, Oregon. The clinic specializes in cardiology, urology, pulmonology, oncology, neurology, thoracic surgery, gastroenterology and general surgery. These specialties mean the clinic receives a large volume of lab reports that must be immediately available to the physician following delivery to the clinic.

Like many clinics, The Oregon Clinic retained an off-site vendor for external storage and retrieval of patient charts. "We were paying them thousands of dollars per month to store our charts and between $2 and $5 to retrieve each one," says Maili Vonada, the Clinic's EMR application manager.

Growing patient privacy and liability concerns were another downside for paper charts. Patients worry that insurance companies or employers might gain unauthorized access to their medical records and use that information to deny them insurance or employment. That concern resulted in the 1996 enactment of the Health Information Portability and Accountability Act (HIPAA). The Act ensures that patients may access their personal records and strictly controls and tracks access by others. It would be difficult and expensive to meet the law's security requirements with a a paper-based charting system.

The Solution: Ascent Capture

Encore Imaging Systems, a Portland, Oregon-based provider of imaging and document management systems, has developed a way to capture all the benefits of EMRs for the Oregon Clinic.

Encore's approach links Medscape's "Logician" EMR application for clinics with an IMR Alchemy document management system and a high-volume document scanning and capture system anchored by Ascent Capture from Kofax. Encore's own "Magician" software integrates these components into a solution that electronically captures all chart information and permits retrieval and viewing within Logician.

Four divisions currently scan and capture labs and other documents: pulmonology, cardiology, gastroenterology and thoracic surgery. The clinic uses three, 50 page-per-minute Panasonic KV-S2055L scanners and three Ascent Capture scan stations with 25,000 page-per-month licenses. The Ascent stations scan documents, enhance the resulting images, indexes them and then release the images and index data to the IMR document management repository.

Each doctor generates 100 to 150 pages per day for scanning. The three currently scanning divisions typically capture about 3,000 pages per day.

The scanned documents are indexed using an automated database lookup. When the Ascent Capture operator enters the name of the patient, Ascent queries the Logician patient database, retrieves the patient data required for the remaining indexing fields and automatically fills those fields.

Solution Benefits

• Physician Acceptance / Image quality: Many of the lab reports are graphics and the scanned reproduction must be good enough for a doctor to trust their patient's health with it. "Our doctors trust the lab reports scanned with Ascent
• Capture.They never ask to see the original document, " says Maili Vonada, the Clinic's EMR application manager.
• Cost Reduction: The solution has eliminated paper charts within the pulmonary practice, which has slashed external storage and retrieval costs. The practice recycles paper immediately after scanning. Cardiology and thoracic surgery recycle their paper records in one week, substantially reducing storage costs. Other clinic practices will go paperless by 2003.
• Efficiency: Doctors can see more patients each day. The solution has proven such a boon to physician productivity that the clinic's board of directors has mandated that it be extended to all of the clinic's practices by 2003.
• Improved Patient Care: Ensures that patient charts are available to physicians whenever they are needed.
• Improved Patient Care: Consolidates patient records. Previously, if a patient saw doctors within more than one specialty, separate charts were created for each specialty. The solution combines each patient's records into a single electronic chart. A physician can easily cross-reference relevant information.
• Ease of use: "Ascent Capture has been easy to learn and fast and easy to use," Vonada says. "It's a great product."
• Speed: Has met the requirement to capture stat lab reports within one hour of arrival at the clinic.
• Privacy / security / HIPAA: The solution controls and tracks usage down to the level of the individual document. Only authorized users may access documents.
• Versatility: Clinics can scan and manage HR, billing, and other office operations with the document management component of the solution.

Kofax Image Products, is a leading supplier of both application software and image processing products for the imaging, workflow and document management industry. The company specializes in the electronic document capture market, which is essential to helping paper intensive organizations economically, reliably and securely incorporate paper-based information into their electronic business processes. It is a member of the DICOM Group plc.