From electronic document management to EHR: Colorado healthcare system eliminates multiple manual processes and brings clinicians closer to instant data access with the right technology

Health Management Technology, Jan, 2005 by Elaine O'Bleness

When Banner Health's Colorado Region began drawing up plans for a new outpatient diagnostic center in 2001, the facilities ties staff kept asking me how much square footage to set aside for medical records processing in the new facility. My answer each time--"none"--may have surprised them.

However, I knew that if we set aside space for medical records, people surely would start storing paper records there. Next, we probably would have needed an FTE for filing and processing. I stuck to my original position, and today the Summit View Diagnostic Center generates only paper copies of consents and orders. In the next few months, Summit View Diagnostic Center will start scanning consents and orders, so that all documents are electronically delivered to our central Health Information Services office at North Colorado Medical Center (NCMC).

It Takes an Evolution, Not a Revolution

The Summit View story is just one example of our evolutionary march toward adoption of a comprehensive electronic health record (EHR) that can connect eight facilities in Banner Health's Western Region. Banner Health is the nation's fourth-largest nonprofit secular healthcare system.

The process began more than five years ago when we replaced our document management and distribution system. After being notified of a significant increase in annual maintenance fees, we began evaluating more cost-effective alternatives. In reaching out to our colleagues facing similar situations in other organizations, we discovered the QuickRecord Suite, a solution now offered by Atlanta-based Optio Software.

After a thorough evaluation, we determined that the product's subscription-based pricing model made perfect sense for us. The monthly fee, based on the number of facilities using the solution rather than the number of named users, worked well within our operating budget.

From the beginning, I recognized the broader potential of the system and started my own social movement within the region. However, back in 1998, I could not have fore-seen how for us, QuickRecord Suite would develop over time into an EHR-lite solution that would bring together both scanned documents and discrete data from our HIS and ancillary systems into a common clinical repository.

Different Uptake Speeds

As we incrementally rolled out the system in our facilities, we trained hundreds of users ranging from medical records staff to nurses and ER physicians. As expected, some doctors were quick to embrace the technology, while others had slower uptake speeds.

Rather than mandating use of the QuickRecord Suite, we promoted the benefits of electronic access while continuing to provide flexibility for physicians and their staffs to receive documents and information any way they wanted, whether via print, fax or Web. By the same token, some doctors choose to sign orders and reports electronically, while others still prefer to sign the printed documents. As a result, we have been able to gain a relatively wide acceptance for the technology among physicians and their staffs while improving productivity.

We started our implementation in smaller areas such as outpatient lab, radiology and pathology, and gradually increased access to clinical information across other departments and facilities throughout the region. In the process, we were able to eliminate the storage of hard copies of outpatient clinical reports and diagnostics such as lab reports as early as 2001 in NCMC, our largest facility. The NCMC emergency department (ED) was among the first clinical areas to begin accessing electronic medical records through the software's Web-based QuickChart module.

In the past, quality assurance, infection control, risk and trauma staff spent hours auditing huge stacks of charts in the medical records office. One by one, we converted all these users into champions of the system. Today, they access the charts via QuickChart's secure Web browser, rather than spending hours flipping through physical records, so they can complete chart reviews, quality assurance work and emergency room follow-up studies much faster than before.

The system had a significant impact on health information management (HIM) workloads. It eliminated approximately 60 percent of requests for physical medical records, wiped out HIM backlogs and resulted in improved employee morale and retention rates.

The End of 'Sneakernet'

The system also helped eliminate many manual processes. A few months ago, we implemented a new patient tracking capability in QuickChart that tracks the location of the patient in the hospital at all times through an interface to our ADT (admission/ discharge/transfer) system and automatically prints transcribed documents at the nursing unit serving the patient. In the past, these reports were printed in the medical records department and manually delivered via "sneakernet" to hospital units four times a day. No matter how fast our transcription turnaround was, getting information out to the floors depended on those four runs. If you missed a run, it might be hours before a report reached your unit. Now these reports get to the patient unit immediately after they're signed off on.