Hindered by its paper-based charting system, Mary Washington Healthcare incurred costs for processing and storing paper charts, and also dealt with delays caused by single copies of patient records. The healthcare provider needed to move from its outdated, paper-based medical charts to an electronic system and chose a medical document management and imaging solution from 3M Health Information Systems, a Microsoft Gold Certified Partner. After deploying the solution, Mary Washington Healthcare nearly eliminated paper from its charting procedures while reducing costs and improving productivity. Two years after implementation, the healthcare provider’s experience with the solution became a valuable resource to 3M in developing a new release. Mary Washington Healthcare worked as a beta partner and, using the upgraded software, increased chart view functionality and simplified IT management.
Mary Washington Healthcare is a not-for-profit regional healthcare system that serves more than 359,000 patients annually in two hospitals and additional healthcare facilities. In 2006, while Mary Washington Healthcare was planning for significant growth internally, the health information management (HIM) team received a directive to improve outdated, paper-based processes.
||We have seen our costs minimized in so many areas. We were able to eliminate the off-site storage of documents, supply costs are down, and we’ve reduced the size of our [health information management] staff.
Director of Health Information Management, Mary Washington Healthcare
“We were faced with the basic challenges of paper—everything from purchasing the paper to filing and storage,” says Evelyn Bickley, Director of Health Information Management at Mary Washington Healthcare. “We had a lot of extra people working to support the processes.” Because hospitals in Virginia are required to keep patient records for six years, Mary Washington Healthcare was leasing an additional storage facility to house all the paper files and employing a full-time staff person to transfer files between the hospitals and the storage facility each day.
On-site productivity was hampered by the paper-based system. “There were efficiency limitations simply because only one person could view a chart at a time,” Bickley says. Coding charts—the process of assigning medical codes to represent a patient’s medical diagnosis and the procedures performed—was a slow process that had to be completed onsite. Additionally, the hospitals experienced delays in processing discharge paperwork, which affected the continuum of patient care and postponed billing. Also, various types of forms and documents were not consistent throughout the healthcare provider’s locations.Solution
To address the problems associated with paper-based processes, Mary Washington Healthcare decided to switch to an electronic medical record (EMR) system. The healthcare provider turned to its longtime technology partner, and Microsoft Gold Certified Partner, 3M Health Information Systems to learn about its document management and imaging solution using the 3M™ ChartScan™ Software, 3M™ ChartView™ Software, and 3M™ Electronic Signature Authentication (ESA) Software suite.
Establishing Electronic Charting
After determining that the solution would meet the healthcare provider’s needs, the health information management staff at Mary Washington Healthcare worked with 3M on an implementation plan. The HIM staff introduced the EMR solution to medical and support staff at departmental meetings leading up to implementation. “We started in the Emergency department and then rolled out unit by unit from there,” says Bickley. “Within three to four months, the solution was deployed throughout the hospital.”
The healthcare provider uses 3M ChartScan Software to scan and electronically capture patient records, resulting in a dramatic decrease in turnaround time in which information is available. 3M ChartView Software provides security-enabled access to patient charts to multiple users concurrently. Authorized users can access charts while working at a computer on the hospital network or from any location using a web browser and the Internet. And by using 3M ESA Software, physicians can view, update, and electronically sign patient documents from any computer at any time.
Also, Mary Washington Healthcare established a standard set of documents that are now bar-coded for system recognition. “If we come across a document that doesn’t have the appropriate bar code, we now know right away that it is not an approved form and consequently can’t be input into the system and needs to be reviewed,” says Bickley.
The 3M suite of products worked with the existing technology infrastructure at Mary Washington Healthcare, including the Windows Server 2003 Standard Edition operating system, the Windows XP Professional operating system, and Microsoft Office Professional Edition 2003. “The Microsoft software in the IT infrastructure at Mary Washington Healthcare interoperates easily with the 3M document imaging solution to provide a seamless user experience,” says Rami Kandel, Manager of Document Management at 3M Health Information Systems.Making Improvements to the Solution
In 2009, more than two years after deployment, Mary Washington Healthcare was happy with the solution but saw additional areas for improvement. For example, physicians faced two different user interfaces for chart access depending on whether they were on the hospital network or using the Internet, and that made the system challenging and sometimes confusing to use. Many physicians preferred the network user interface because the web interface proved problematic at times.
||Mary Washington Healthcare has reduced the time to process a discharged patient’s paperwork from an average of five days to less than 12 hours.
Manager of Document Management, 3M Health Information Systems
“Because we had outgrown the earlier versions of 3M ChartScan and 3M ESA [that we were using], the web application was unable to efficiently process our extensive data,” says Alex Staranowicz, Systems Analyst at Mary Washington Healthcare. “There were latency problems.” As a result, physicians would wait to input information until they were back in their offices, negating the benefit of being able to access charts from anywhere.
While the electronic charting system was much faster than waiting for paper files to be retrieved from off-site storage, the sheer quantity of information could take a long time to be retrieved from the server because of hardware and software limitations. “A single chart for an average seven-day hospital stay can be 900 to 1,200 pages long,” says Staranowicz. “These charts could take up to three minutes to display when needed. That is a long time for a physician wanting to check something while treating a patient.”
The applications required significant downtime to perform ongoing maintenance and updates. These updates were time-consuming and inconvenient. For example, IT staff worked through the night once every three weeks to perform system maintenance during off-peak hours.
When the healthcare provider learned that 3M was preparing a new release of its document management and imaging solution, Mary Washington Healthcare was interested and determined that it was the appropriate time to upgrade its hardware and software. The healthcare provider invested in nine new Dell PowerEdge R710 Rack Servers and upgraded to Windows Server 2003 Enterprise Edition.
In October 2009, Mary Washington Healthcare began working as a beta partner for 3M on the new release of its solution. “3M provided a project manager to work hand in hand with Mary Washington Healthcare to ensure the new release addressed the healthcare provider’s concerns,” says Kandel. “Our team was onsite to provide management and support during the conversion.”
Issues brought up by Mary Washington Healthcare were reported to the 3M Health Information Systems project manager and then routed to the development team to make necessary improvements. Mary Washington Healthcare went live with the new release of the 3M solutions, called Platform 7, Feature Pack 2, in December 2009.
Feature Pack 2 provides numerous improvements to address the needs of Mary Washington Healthcare. For example:
Mary Washington Healthcare saw significant benefits from both phases of its electronic charting solution. After the first phase of implementation, Mary Washington Healthcare experienced cost reductions, as well as dramatic improvements to productivity and document standardization. The solution’s second phase provided improved document access and simplified IT management.
Reduced Operating Costs and Optimized Staffing
“We have seen our costs minimized in so many areas,” says Bickley. “We were able to eliminate the off-site storage of documents, supply costs are down, and we’ve reduced the size of our HIM staff through attrition. Because of gains in productivity, we didn’t need to rehire for those positions.”
Since the implementation of electronic charts, the medical coding positions at Mary Washington have changed from on-site contractors to remote employees. “Previously, we were restricted in who we could hire to code because the coders needed to be onsite to access the paper charts. We were forced to use contract people,” says Bickley. “Now, our coders can access charts using a security-enabled web browser and the Internet, so we hire who we want regardless of their location.” Because coding is now done by employees working remotely, Bickley adds, “We no longer have the extra costs associated with continually hiring and training contract coders, nor do we have to provide them with physical space.”
During a recent period of expansion, Mary Washington Healthcare managed to avoid hiring supplemental staff even though the number of charts and coding volume increased. At the same time, the healthcare provider permitted attrition to reduce its full-time HIM staff by 9 percent.Increased Productivity
The shift from paper charts and manual documentation to electronic charting has helped Mary Washington Healthcare greatly improve productivity. Patient records can be viewed by multiple users at the same time, thus eliminating the bottlenecks created by having only one paper record. The electronic charts can be viewed from any computer, whether within the Mary Washington Healthcare system or offsite via a web browser with appropriate security measures. Physicians are able to review and approve transcribed documents electronically, resulting in accelerated processing time.
||It takes three seconds to see what used to take three minutes. That’s a big difference to a busy doctor—and to a patient.
Systems Analyst, Mary Washington Healthcare
“Mary Washington Healthcare has reduced the time to process a discharged patient’s paperwork from an average of five days to less than 12 hours,” notes Kandel. And with employee time freed up by increased productivity, Mary Washington Healthcare is able to validate the quality of the documentation and make sure that all documentation is complete. Established Standardized Documentation
One unexpected improvement was the healthcare provider’s ability to standardize documentation. “Many times, if staffers needed a form or document, they would simply create a new one because we didn’t have a solid form management process. We had nearly 1,200 different types of documents,” says Bickley. Since implementing the electronic system, Mary Washington Healthcare has been able to reduce the number of forms significantly.
All forms have a bar code for the type of form, as well as a bar code individualized for each patient at admission. This precaution helps ensure that forms remain standardized and that each record can be traced to the proper patient.Improved Document Access
With the new implementation, healthcare providers have a single user interface for viewing charts, eliminating confusion and delays. “Physicians are much happier with the single user interface,” says Bickley. “They can access charts from their office or at home, and the information displays exactly the same now.”
In addition, with the new database management improvements to Platform 7, 3M ChartView runs faster and displays charts more quickly, significantly reducing the amount of time physicians spend reviewing and completing charts. “It takes three seconds to see what used to take three minutes,” says Staranowicz. “That’s a big difference to a busy doctor—and to a patient.”Simplified IT Management
With the addition of Microsoft SQL Server 2005 to support Platform 7, Mary Washington Healthcare IT management can schedule regular maintenance for the solution without being present. “I’d rather not make a trip to the office in the middle of the night once a month,” says Staranowicz. “It’s great to have the whole process automated.”
With the back end change to SQL Server 2005, the IT team reduced the total number of servers that support the network. “We’ve gone from managing 22 physical servers down to 17,” says Staranowicz. “That saves us time and money.” With the reduction of servers and the improvements to the monthly maintenance, Staranowicz estimates that the IT department is saving 7 to 10 hours a month.Microsoft Solutions for the Healthcare Industry
Healthcare and life sciences organizations are under tremendous pressure to meet regulatory requirements, improve patient care, and reduce the time it takes to develop drugs and take them to market. To meet this challenge, Microsoft and its partners have developed cost-effective solutions that enable healthcare organizations to streamline and automate daily processes that improve productivity and deliver information whenever and wherever it is needed. The result is enhanced productivity, safety, and quality.
For more information about Microsoft solutions for the healthcare industry, go to:For More Information
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