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December 8, 2008

Scanning Technology: Improving Images
By Laura Gater
For The Record
Vol. 20 No. 25 P. 6

Upgrades have helped two organizations become more efficient.

New Mexico’s Las Clinicas del Norte and Wyoming Medical Center in Casper have something in common other than their remote locations: At one time, both were drowning in paper records but now have joined the modern age by purchasing an electronic medical record (EMR) system that can scan paper documents into digital records. They are among the growing number of healthcare facilities across the country that have turned to EMRs as a partial or complete solution to paper clutter.

Last year, Las Clinicas del Norte adopted eClinicalWorks as its EMR/practice management vendor. But it still needed to get its existing paper records into a digital format. To address this issue, it purchased technology that enables the staff to scan documents through an integrated keyboard while sitting at their desks. The keyboard scanner allows users to activate and complete scanning by inserting a document into the scanner feeding slot.

“During the planning stages, we looked at the needs of the staff and decided to get a scanner for any staff person who needed to scan documents into the system,” explains Desi Lopez, Las Clinicas del Norte’s IT director. “We started off with just a few high-speed duplexing scanners, but as more staff became proficient in using the EMR system and needed to get data into it, we saw that some small scanners would be beneficial to anyone who doesn’t have a high volume of scanning. The KS810 scanners (from KeyScan) were ideal. They fit our needs quite well when a large volume of scanning isn’t necessary.”

Meanwhile, Wyoming Medical Center, which began its paperless odyssey in 1996, recently upgraded to IBML ImageTrac scanners in an effort to improve efficiency. HIM director Nick Belveal notes that the process is “substantially different” between the old and new scanners. Where staff once had to scan one document at a time, they now can load all document pages at once, thus doubling the output.

Belveal says the old technology scanned about 120 pages per minute, while the new system can scan 240 pages per minute, an important statistic considering the facility is still working through a substantial backlog of old records—12 years’ worth, in fact. The new scanners will enable the staff to complete this enormous task in 12 to 18 months, a substantially shorter period of time than the seven years Belveal estimates it would have taken using the previous scanning system.

The Scanning Process
Staples and paper clips must be removed from all documents to be scanned. If a page is wrinkled, it is copied on a flatbed copier to produce a page that can be fed into the scanner. At Wyoming Medical Center, prepping the old documents is the most significant obstacle to overcome during the scanning process.

Las Clinicas staff members don’t need to scan entire records. According to Lopez, a physician may want to have certain test results or forms from the paper chart scanned, but the majority of the chart is historical, so after a couple visits to the office, all the pertinent data have been entered into the EMR. He says the need to refer to the paper chart or its scanned version is diminished.

“Our front desk staff need to scan income forms, tax returns, insurance cards, etc. For a single page or a few single-sided pages, the KS810 scanner works well,” Lopez says. “Our nursing staff need to scan in other types of documents, from faxed lab results to paper charts and reports from other doctors. They do the bulk of the scanning and since their volume of scanning is much higher, they have a high-speed duplexing scanner at their desks. Our billing staff scans copies of checks they are posting and explanation of benefits [EOB] forms from insurances, and since most of those are a single page or just a few single-sided pages, they use the KeyScan scanner at their desk. If a large insurance check comes in, that usually means the EOB is more than just a few pages long, so they will take it to a nurse’s station and use the high-speed scanner.”

At Wyoming Medical Center, because documents appear in the EMR in the order they’re scanned, the HIM department scans them chronologically, says Belveal. X-rays are stored in a picture archiving and communication system, but the report is exported into the EMR. The scanner can input documents up to and including legal size (8.5 X 14 inches), and it can also scan pictures.

“The biggest thing about our new scanner is that it catches duplicate pages,” says Belveal, who adds that eliminating duplicates saves not only time but also space and wasted paperwork.

At Las Clinicas del Norte, the scanners cannot scan x-rays, but that’s not a priority because patients receive a copy of their x-rays on a CD. The clinic then imports the pictures from the CD into its EMR system.

Security and Savings
Las Clinicas del Norte’s EMR system interfaces directly with the scanners, so it controls the scanning and saves the images. The security features that are part of the EMR system allow Lopez and other directors to decide who has permission to perform certain functions in the system.

“We are a free-standing clinic with three main locations and also run a couple of school-based clinics that all use the EMR system,” he says. “At our administrative site, we house the server for the EMR system and have dedicated T1 lines between our other main clinics, and the school-based clinics use a VPN [virtual private network] to connect to the server remotely. Each staff person has their own user login and password and is assigned permissions letting them access certain functions of the EMR system.”
Wyoming Medical Center also employs password-protected security measures to restrict staff access to the EMR. Use of the scanner is also monitored, so not just anyone can input documents into the system.

Belveal estimates that over a five-year period, the new ImageTrac scanners will save Wyoming Medical Center about $350,000. He says becoming paper free is the hospital’s goal, but he does not envision that becoming a reality until the facility’s older doctors have retired. Meanwhile, the next generation of physicians will demand a paper-free environment, and he wants to be ready.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.