Document solutions keep paperwork
from crowding out focus on patients

Behind every medical center is a mile-high pile of pre - printed forms. Forms for collecting patient history, filing insurance claims, tracking inventories, writing prescriptions, scheduling appointments and ordering tests.

Even as hospitals transition to electronic health records (EHR), the paperwork burden continues to consume a staggering share of the healthcare business each year. Estimates from the Office of Information and Regulatory Affairs show doctors took 105 million hours of their time to send the Health Care Financing Administration (HCFA) 1.7 billion forms at a cost of $57.4 million in 2000. Even that number is low, because it assumes a physician can complete a 30-page form in 15 minutes. Sadly, HCFA forms comprise only a fraction of the total paperwork load.

"Hospitals are spending thousands of dollars to keep stacks of preprinted forms on their office shelves," Singer says. "Those funds could really improve patient care if they were funneled to other aspects of the treatment process, hiring additional personnel or purchasing better equipment. As it is, many are still shuffling papers."

Paperwork is not just a drain on the budget. It is also heavily time consuming. A PricewaterhouseCoopers study in 2001 found that every hour spent with a Medicare patient in the ER requires one hour of paperwork. As a result, medical centers have been forced to divide their focus between healing and administration. There are four times as many clerks and managers in health care as there are doctors. In an industry devoted to health and wellness, papers have cluttered the path to healing. While the need for detailed records is not likely to change, solutions have emerged that would limit the need for paper.

Finding the answer

"Most hospitals spend hundreds of thousands of dollars per year on paper," Rich Singer, Manager of Process Management at HMS says. "They are throwing away valuable resources and man-hours just to process all of those paper forms. We at HMS got together and knew it did not have to be that way. Now how do we want to fix the problem?"

Integrated Forms was the answer. An electronic archiving solution developed by a team at HMS, Integrated Forms allows medical facilities to keep more accurate records without the enormous stacks of paper that crowd many office shelves. It integrates necessary forms into the natural workflow and keeps paperwork from crowding out a focus on treatment.

However, the solution did not spring up overnight. Singer and a team of developers spent months evaluating alternative solutions and honing their own answer to the paperwork problem.

"We looked at the problem by counting every document used in each service at a typical hospital from the time a patient enters the building to the time he or she leaves," Singer says, "and we found 60 to 100 pieces of paper for any given visit. That is when we really got rolling."

The team evaluated the various forms, determining where there was duplication or waste. By looking at the big picture, they were able to reorganize and streamline the process. Then, they took the slimmed-down set of papers and turned them into printable, electronic forms and integrated, intelligent forms that are completed entirely on the workstation.

They did not stop there. Now that the forms were electronic, they could be printed on-demand, with the computer figuring out which forms were required for each patient visit. Personnel only had to pull up a patient's name to print the forms that would be needed for that visit.

However, there was another crucial step: how to take the 'grunt work' out of the forms for hospital personnel. So HMS enabled the forms to populate with patient identifying information and other data from the patient's record as needed. "Now the computer does the grunt work instead of a nurse or doctor," Singer says. That is the key to solving the paperwork problem. The only paper involved in Integrated Forms is the paper nurses and doctors want to write their own notes on. Everything else happens automatically. It limits human error, saves time and money and cuts down on the avalanche of forms that have bogged down medical centers in recent years.

And most importantly, it gets healthcare providers back to doing what they were hired to do in the first place, deliver patient care.

ROI on eForms

• Eliminates thousands of forms healthcare providers fill out each day, allowing them to treat patients rather than process paper.
• Increases patient safety by eliminating room for error.
• Gives your hospital a greater return on the HMS investment, freeing much-needed dollars for improved patient care.
• Optimizes your hospital's workflow processes, thereby increasing productivity and efficiency.
• Improves the appearance and design of medical forms, increasing your hospital's branding efforts.
• Adapts to each HMS customer through customization to fit individual needs.

Case study:

Community Hospital of Anaconda
Location: Anaconda, Mont.
Type of Care: Critical Access Hospital
Number of Sites: Hospital, 65-bed nursing home, 2 physician clinics

A history with HMS - Mary Bisch, HIM Director

Our facility has been an HMS customer since May 1998. A few years ago, we noticed our facility was experiencing a common problem: too much paper and not enough space. With the onset of the industry-wide initiative for automation, we began asking ourselves, "Where can we reduce paper?"

Working the problem

In 2005, we began creating electronic forms " focusing on business office forms first as well as forms for Social Services and HIPAA forms. Then we proceeded with electronic forms in the ER and surgery departments, followed by the ancillary departments and forms for the clinics. In 2007, we began working on physician standing orders forms " the most time-consuming.

We also implemented scanning, starting in the business office (insurance cards, consent forms and Explanation of Benefits) and in HIM after we implemented Clinical View. With HIM we began by scanning all ER records and outpatient encounters including outpatient surgeries, observations, etc.; we wanted to ease into the process to give staff a chance to get used to viewing scanned documents before we started scanning in inpatient.

For scanning in Admissions/Registrations, there are special tabs set up for the individual documents that need to be scanned in, and you can then view those scanned documents through Clinical View, HIM or the business office system. When you bring up a patient's account information, you can view the tabs that are set up, whether it is batch scanning in HIM or a UB the business office has scanned in. We are also scanning the advanced directives handled by our social services director. Once she gets a copy of a patient's advanced directive, she brings it to us to scan it into the scanned documents and file under the tab for advanced directives.

Now that scanning has been implemented, Clinical View as a retrieval tool has really helped our clinicians undertake some quality improvement activities because of the greater accessibility afforded by not having to wait for charts.

The solution sets in

Electronic forms have saved us thousands of dollars on costly, pre-printed forms, and the forms look very professional and standardized. In addition, using the electronic form packets saves even more time for the ward secretaries instead of copying packets for ER and the medical floors. With the scanning, we couldn't be happier: it's made for quick retrieval of information from past visits.

While we as a facility have benefited from the amount of time, money and man-power saved on document retrieval, the patient has benefited as well. Electronic forms have increased accuracy of patient identifying information (which is clearly labeled on all forms) and have helped us eliminate misfiles in the patient chart.

Looking to the future

HMS staff has been very helpful with implementation, training and support and contributed to the overall success of our paperless initiatives. Our goal for 2008 is to contract out the scanning of the past couple of years of documents to chip away at the file room; what's left of the file room, we'll move off-site. Our facility does have goals to complete our EHR, and once the scanning of past documents is completed, we should be close to 100% of that goal.