January 10, 2003

VMG to be ‘paperless’ by February

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Oral surgery’s Lyndi Hopkins scans and indexes documents to create a completely electronic outpatient record. (photo by Dana Johnson)

VMG to be ‘paperless’ by February

For the past several years, in addition to being available in traditional paper form, major parts of the Vanderbilt patient record, including test results, most clinical notes, and inpatient orders, have also been available in electronic form. The electronic version is distributed to the appropriate health care providers via a Web-based Vanderbilt application called StarChart.

Patient care efficiency increased with the introduction of StarChart (originally called MARS), but it was still necessary to consult and maintain the paper outpatient chart. That’s no longer the case.

By February all Vanderbilt Medical Group outpatient practice areas will be routinely scanning and indexing all of the clinic’s remaining paper chart documents, including outside test results and referral letters, forms for collecting patient history and consent, and all other documents.

In the meantime, StarChart has been made much more useful for managing patient groups. It’s been linked to clinic scheduling and hospital admission systems and a messaging function has been added to streamline communication between members of the patient care team. This souped-up version is called StarPanel.

The combination of StarPanel and scanning removes paper-based processes from outpatient areas, paving the way for improved quality and efficiency. The project is called E3, as in electronic by 2003.

The immediate benefit is that doctors and nurses no longer need to request records and root through sheaves of paper to find patient information. E3’s eventual impact on patient care quality can’t be overstated, as the project sets the stage for automated clinical decision support, automated outcomes tracking, and greater standardization of practice.

E3 is projected to bring $1.7 million in labor savings this fiscal year, and, by paving the way for electronic documentation tools, the project will eventually save additional millions in transcription costs.

VMG has pledged that no staff will be laid off or forced to accept lesser paying jobs because of E3 work redesign. Staff who handle patient records will transfer to other positions. The Adult Primary Care Center was able to eliminate 3.9 filing positions; they’ve found that one person working a 30-hour week can handle all scanning and indexing for the center, which has around 25 attending physicians. The affected staff were promoted as patient services coordinators.

Every document is scanned and indexed to the patient record the same day it appears. In case of system failure, backup Web servers ensure electronic records are not lost. Currently having 14 major headings and 20 subheadings, the electronic record is organized along the lines of the traditional paper chart.

Clinics are scanning historical patient records as needed. Pediatrics practices, for example, are choosing to go back to capture immunization and growth chart records from the start of care. Other clinics are pulling the paper chart prior to a patient’s visit, selectively scanning whatever might be needed for the future, then sending the paper file to long-term storage. Yet other clinics are bringing staff in over a few weekends to scan every record back to a certain date. It’s expected that all clinics will have purged paper records within six months to a year.

• Higher volume clinics use a scanner connected to a dedicated computer workstation. It takes less that two seconds to scan a page (scanners have loading trays and automatic feed) and images are automatically transferred to the clinic’s own indexing queue within two minutes. One person scans and indexes.

• Lower volume clinics use a more economical solution, swapping out the lease of a normal copier for the lease of a network-capable copier/scanner. Just like scanners, the network copiers automatically forward images to the clinic’s document queue. Multiple staff scan images on the copier while a single staff member handles the indexing.

• The lowest volume clinics are faxing documents to their image queue.

It takes each clinic two to three weeks to implement scanning. Training is by members of the E3 project team, with medical information services providing quality assurance. Many clinics got started in November and December. Pediatrics and cancer will start in January, and orthopedics and dermatology are planned for February. A new job position is being set up for medical records indexing/scanning. In each clinic, a primary and a backup are trained for the job, with additional backup available from medical information services. If a clinic doesn’t have an available staff member, the job is assigned to medical information services.