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.
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
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.
- 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
- 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.
Kofax Image Products