By James Bowden, Director of Patient Financial Services, Palisades Medical Center
Since I became director of patient financial services at Palisades Medical Center in North Bergen, N.J., in 2008, I've been on a mission to round up and digitize every paper document related to patient care before we begin our EHR installation in 2011. By the time Palisades goes live with Siemens' Soarian system, all of our patient billing information will be under the control of a document imaging and management system.
Paper & Financial Woes
Palisades is made up of a 202-bed hospital, a 245-bed nursing home and a rehabilitation center, and treats approximately 160,000 patients annually. I was hired to run Palisades' business office operations and improve revenue cycle management. When I arrived, I was confronted with a mountain of paper documents. The staff was copying an average of 20 pages of documents per patient, and storing them in filing cabinets throughout the hospital. This did not include the patient's 40-plus electronic forms and images stored on servers.
When the billers had to retrieve patient files for billing discrepancies they would have to walk 15 to 30 feet to a filing cabinet and try to find paperwork that was often misfiled or lost. Or the documents were stored offsite at rented facilities where we housed thousands more historical records at a pretty costly fee. Palisades was accumulating millions of paper documents each year and spending a great deal of time and money trying to find patient information. I was determined to make hard storage file cabinets of over-stuffed patient folders a thing of the past.
When It Rains It Pours!
Shortly before I arrived at Palisades Medical Center, the hospital experienced a flood and a good portion of the patient billing records, which were only in paper form at the time were destroyed or totally unusable. Believe it or not, two years later the hospital experienced a second flood [in March 2010] -- just three months after going live with our document imaging system. While we had already begun the process of electronically scanning patient documents nearly 200 boxes of paper records had to be freeze-dried to recover the data. That fiasco cost the hospital about $20,000. But it could have been a lot worse if it weren't for starting the document-scanning project in November 2009.
The first step toward overhauling patient billing operations was to identify all the issues our staff experienced during patient registration, then developing the electronic workflows using the document management system to guide billers and clerks through the patient registration process.
The document management system would show the staff what paperwork (prescriptions, orders, referrals, authorizations, etc.) and insurance information was to be provided at the time of registration. It would take a picture of patients while they were sitting in front of admission clerks. This would eliminate the patient returning months later denying that they had received these services that we were billing them for. The proof was in the "picture."
I was very lucky that Palisades' CFO was my boss at a previous hospital. I worked for him for eight years prior to coming to Palisades. He knew all the benefits of document imaging software. The hardest problem we faced was the decision to spend money on this project when the hospital had so many other financial worries at the time. When I convinced our CFO that financial collections would improve dramatically, we obtained all the approvals we needed for this project.
Cutting Paper Overload
My initial goal was to convert every paper document to digital form, starting with patient accounting records.
We chose RASi, a document management system from DB Technology because it had more flexibility and was less expensive than competing products. RASi took us less than three months to install without requiring any custom programming. Heavy I.T. resources were not needed for the implementation, which was also a big selling point.
The basic RASi package stored electronic reports for our Siemens Invision hospital information system. The RASi imaging module gave me all the capabilities to scan, compress and archive the paper documents brought to us by the patients, and "smart link" them to individual electronic patient folders, allowing us to maintain all patient "paperwork" in one location. Our staff could submit individual patient queries to RASi and retrieve the correct information within a few seconds. They could also access real-time and archived information in report form.
Mission to Eradicate Paper a Success So Far
Ironically, the hardest part of the project has been getting the deployment of all the scanners to various locations in the hospital. The planning for future growth is very important here. As soon as other hospital departments become aware of what RASi can do, they want the system for themselves. The truth of the matter is that RASi is very expandable and functional in many areas. I can see RASi expanded to Payroll, Human Resources, Administration and Medical Records, Radiology, the Nursing Home area and many other areas in the future.
Today the technology is managing all patient admission and registration forms for emergency, outpatient, inpatient, wound care, mental health and our sleep center. So any paper document the patients bring to the hospital upon registering, i.e., drivers license, insurance card, drug prescriptions, physician referral forms, consent and release forms, etc. are scanned and managed in RASi electronic folders. If one of the registration clerks copies downs the wrong insurance card numbers we have a second chance to go back into RASi and get the correct ID number.
As the patient goes through clinical treatment, services are coded, and bills are dropped by Invision and circulated through the billing office for insurance eligibility review. If we need to look up eligibility we can go back to RASi to check the electronic patient folder for insurance coverage and make any necessary changes. Since we get an average of 35 out of 100 bills initially denied by HMO and commercial payers or delayed in the payment process by the insurance carriers, the patient registration information stored in RASi provides easy proof that a specific treatment is covered and authorization has been obtained.
Because we now have all the paperwork for the patient's episode indexed in our computer system, it is very easy to determine what the situation was when the patient walked in the door. Did the patient provide us with the correct insurance information? Did we attempt to obtain a pre-cert and what were we told by the person on the other end of the phone? If we have a picture of the patient we serviced that patient cannot deny his or her identity. Sometimes, the patient even admits to us that they know the person in the picture. That leads to a very interesting conversation!
The Future of Document Management at Palisades Medical Center
We are now working on printing barcodes on all 64 patient registration and clinical forms to identify patients' medical records, patient account numbers and form numbers (for indexing purposes). Our billers will be able to scan a stack of documents in no particular order and RASi will direct these documents to the proper electronic patient folders. We have just completed scanning all managed care contracts and making them accessible to staff through RASi.
In 2011 we plan to scale RASi to manage non-patient information, including administrative management contracts, purchasing, shipping & receiving documents, accounts payable, and possibly payroll and our human resource department. There is no end to the process and the potential future savings that we can get from RASi.
And even when we finally go live with electronic medical records, no matter how advanced our EHR system is, there will always be lose paperwork floating around that will need to be added to the patient's medical records. It is our intention to use RASi to merge paper with our electronic files.
Contact information for Jim Bowden: 201-854-5035, Jbowden@PalisadesMedical.org.
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