August, 1996 Improved patient care through document imaging Benefits from technology go beyond the bottom line By Rita Marcojohn, Vice President Product Management Imaging Products, Fujitsu Computer Products of America, Inc. When asked why Doctors Medical Center of Modesto, CA, made an investment in document imaging, Debbie Fuller, Director of Health Information Services, is emphatic in her reply: "To improve patient care! We want to deliver patient information in an expedient fashion, to anyone who needs it." Document imaging provides instant access to patient records, allowing more rapid assessment of the patient's needs and requirements. Traditionally this information is stored in the medical records department in conventional filing systems. At Doctors Medical Center, all of the patient's records are stored in the imaging system, including both scanned documents and computer-originated documents (COLD). The patient records are available wherever they are needed, with access through workstations on a LAN. The benefits of electronic medical records are so impressive that document imaging systems are rapidly expanding in the healthcare field. The Medical Records Institute has published a survey of "approximately 200 document imaging installations in healthcare provider settings nationwide." Doctors Medical Center and others are leading the way in a fundamental shift in the way healthcare providers and payers manage patient information. According to a report by the Los Alamos National Laboratories, "it is useful to think of the patient's medical record as an entity that exists on the network in its aggregate form simultaneously populated from multiple locations." In the practice of medicine, paper is used everywhere, and its familiar flexibility and convenience guarantee that paper is not going away any time soon. Accordingly, it is very important to have an efficient means of entering paper documents into the electronic records system. At Doctors Medical Center, policy dictates that all patient records are scanned upon discharge. A Fujitsu m3099 scans 6,000 pages per day as part of standard operating procedures. "These are all sorts of pages, that have been handled by all sorts of people." Anyone who has visited a hospital is familiar with the patient charts that hang at the end of every bed. These pages are generated by many processes, and include a huge variety of NCR pages, flimsy, crumpled and written upon with a myriad of pens, pencils and otherwise. Beyond all of the technical capability of today's hardware and software, the focus must always be on the primary function of the organization. No matter what the form of automation, the least part of the equation is the technology itself. The human service is always at the heart of the issue. And nowhere is this more starkly true than in the critical setting of healthcare providers. In hospitals and all healthcare environments, the highly trained professionals on staff are heavily burdened. Any tool that can either reduce the burden of menial tasks or avoid menial tasks entirely for physicians and other care providers will assuredly serve the patient better. However, these busy professionals cannot afford to add new jobs to their daily regimens. As Ms. Fuller explains the acceptance of the document imaging system, "physicians are pretty happy because patient information hasn't changed into 'data.' The images still retain the familiar format of charts and records." Hard savings While it is difficult to measure the minutes saved by interns or surgeons who don't have to ask routine questions, one area of clear advantage is evident. When a former patient appears in the emergency room, physicians can refer to easily available medical history information and often avoid costly medical tests. By avoiding repetition of tests, both the patient and staff are saved the time and effort of wasted procedures. More importantly, patient care proceeds expeditiously because the physician is not delayed in coming to a treatment decision by waiting for test results. "Anybody who is caring for patients has access to their information," declares Ms. Fuller. The system is being deployed on a LAN throughout the hospital. Branching out from the successful implementation and the obvious lessons learned of the benefits in the ER, access is also available at nursing workstations. Drawbacks of earlier technology From a document imaging perspective, Doctors Medical offers a classic challenge. The entire concept of more efficient access and handling of documents often assumes that the paper will somehow be magically digitized into image form. However, this point in the application is where the new electronic records are created and is therefore critical to the quality and usefulness of the image documents. The reality is that paper documents vary drastically in terms of their size, thickness and color, but most importantly they vary in terms of their information content. In patient records, the critical information has been written by an assortment of people on a variety of media, in Bic pens, Flairs, No. 2 pencils and everything else. What is obvious to the discerning human eye viewing a piece of paper may be invisible in a scanned image. For example, contrary to common sense, ballpoint pen notations may be invisible to a scanner, because the ink from the pen actually reflects more light than the paper it is written on. In order to deliver this crucial information to the physician on the floor, it is vitally important that the digital document is an accurate and reliable reproduction of the patient record. Some of today's best scanners take advantage of the ever-increasing price/performance ratio of microprocessors. The payoff of high performance is realized when the image enhancement is on board the scanner itself. For example, Fujitsu Enhancement Technology provides an automated set of tools to ensure the most readable images. Given the importance of easily discernible patient records in the emergency room, this on-board processing of the Fujitsu m3099 contributes directly to better patient care. Powerful enhancement routines make the varying page images as readable as possible by dynamically adjusting the contrast to make every meaningful line clear. To compensate for the type of data dropout that may be caused by ballpoint pen lines, a filtering feature actually "cuts areas lighter than their surroundings and increases their density to improve image clarity." In other words, this feature recognizes the glare reflected from the ink and converts those pixels to the original written lines. Another feature, called Gamma Curve Correction, compensates for documents of varying brightness and backgrounds, such as that caused by carbon paper and various medical test equipment. This feature makes the image much more readable on screen than it would otherwise appear. Another feature called Spot Noise Removal also contributes to a cleaner image, which is not only easier on the eyes but also results in smaller file sizes than a dirty image. Image file size is always a consideration in terms of both storage and network transmission, so this feature is key to improving the overall efficiency of the document imaging system. Compared to microfilm, these enhanced images usually offer superior readability. In addition, all of a patient's records can be appended to a single folder, where updates to microfilm records are often scattered across several different rolls or fiche pages. And, of course, these digital images are infinitely more accessible than the physical medium of microform. Consider the task at hand Traditionally, the crumpled stack of paper on a patient's chart has been filed away in an ever-expanding file cabinet system. If a former patient visits the emergency room, the physician on duty formerly had very limited access to records and retrieval was time consuming. Even in less time-critical instances, former patients re-entering the hospital are routinely subjected to procedures and tests that have been performed previously and are already in the patient records. Faced with responsibility for the health, well-being and very life of the patient, the physician must have easy access to traditional patient records. Document imaging, with proper enhancement technology, provides the physician with a reliable facsimile of the patient records. Such records, conventionally stored, are virtually inaccessible in file drawers and microfilm cabinets, or in warehouses and hospital basements. With document images, the physician has instant access to the familiar, reliable patient records, like the chart at the end of the bed. Reducing the cost of healthcare Efficient collection of debt is a key to profitability in any business. Document imaging empowers healthcare providers with the ability to rapidly comply with every requirement for claim payments. Every healthcare insurer and organization demands proof of services and diagnosis before they make payments. Once a patient document has been scanned, as are 6,000 pages per day at Doctors Medical, it becomes a very easy task to look up and send out these documents. The patient records can be easily retrieved and printed for the requesting organizations. The reduction of workload on the service personnel is clearly discernible, and the improvements in efficiency are undeniable. For example, at West Jefferson Medical Center in Marrero, LA, in the patient business services department "follow-up calls have dropped from 2,000 to 1,200 per week" through the use of electronic information management, according to an article in Inform Magazine. The document imaging system directly reduces file handling by a wide array of highly paid staff, up to and including the physicians. In purely financial terms, the healthcare provider organization will benefit from more efficient billing and collections. Paperwork delays will be vastly reduced, and simple requests for documents will often be instantly fulfilled by the document image database. However, as Debbie Fuller of Doctors Medical Center emphasizes, the most important benefit of document imaging in the healthcare environment is improved care of patients. The lifesaving potential for patients is an advantage of document imaging that no healthcare provider can ignore. Rita Marcojohn is responsible for all operations at Fujitsu Computer Products of America's Imaging Products Group (San Jose). For further information, contact Fujitsu Computer products at 800-626-4686 or http://www.fcpa.com.
	TOP OF PAGE		HOME ++ SEARCH IW ++ DAILY NEWSWIRE ++ CURRENT PUBLICATIONS ++ ABOUT IW BUYER'S GUIDE ++ DIIME ++ SUBSCRIBE ++ COMMENTS
	© 1995, 1996, 1997 Cardinal Business Media, Inc. All Rights Reserved. The names, logos and icons identifying CBMÆs products and services are proprietary marks of Cardinal Business Media, Inc. CBM has no liability for content or goods on the Internet except as set forth in the Terms and Conditions of Service.