Document Imaging Systems in Health Care: "Will we ever get rid of all the paper?"

Prepared by Cheryl Waggener

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As a health care consumer, I recently had the opportunity to view the health care reimbursement process from a different perspective. When I contacted the customer service department of my health insurance carrier to resolve an unpaid claim, the representative informed me that she would have to pull the original claim submitted to verify the coding and call me back. Additionally, she advised me that this would take approximately 10 days! I imagined someone digging through stacks of claims and thought to myself - "there's got to be a better way."

We work in a paper-intensive industry, with each patient visit generating an average of 60 documents. Information is the lifeblood of what we do. Yet we still find ourselves in situations where the paper we need to do our jobs exists - somewhere - but isn't accessible where and when we need it to be.

Technologies to improve information management processes, such as workflow and document imaging systems, do exist, but their adoption rate is increasing far more slowly than most industry analysts expected.

Document imaging systems (DIS) typically use a scanner and optical character recognition to convert information on paper documents into digitized bit-mapped images for the purpose of enabling end user activities such as accessing, storing, retrieving, distributing or updating databases. Promoted as a way to eliminate paper and streamline workflow, these systems can result in an increase in time and effort, when organizations fail to plan for the significant cultural change from a paper-based world to an imaged one.

Document Imaging Adoption and Benefits

Providers and payers have successfully implemented DIS in financial and administrative areas as well as for clinical purposes. As a result, they have reaped rewards both financially and strategically. Key DIS benefits documented by health care organizations include:

• Improved Customer Service
• Reductions in Overhead
• Volume Tolerance/Capacity and Revenue Growth
• Opportunities for Physical Expansion
• Improved Patient Care

In 2000, document imaging reached a $6.9 billion industry. Respectable, but a far cry from the $12 billion in 1995 predicted by many analysts. Why the slow adoption? The answer lies in a complex mix of cultural and technological factors.

While paper in-and-of-itself is a commodity, it contents is often the "lifeblood" of an organization. This creates inherent risks/liabilities when opting to change its form and processing techniques. In addition, implementing a DIS can be an expensive, detailed, and labor intensive undertaking. Depending on its attributes, a system for one hospital can range in price from $100,000 to $500,000. It also includes consideration to minute items like scanning requirements (e.g., documents being unwrinkled, free of staples and reasonably legible) and quality control/indexing issues (e.g., what to do if scanned document is illegible, bar coding protocols).

Consequently, DIS, in most cases, has evolved first from a less risky area of a company (e.g., back-office functions) and then, once perfected, expanded to reap efficiencies in other areas of the organization

DIS Success Criteria

Given the high risk/high return potential of a DIS, Information Technology Optimizers recommends that its clients proceed with appropriate caution. The following are recommendations, based on our research and experience with this technology, for maximizing your document imaging system investment:

• Gain support from senior management - a "new way of doing business" needs backing from top levels of organization in order to help combat staff resistance to change.

• Re-engineer the process first - a significant component to maximizing ROI potential is to ensure that you are automating an effective work process. Take into consideration the requirements of the system for quality control - for example, you may have to shift and add resources as well as redesign forms to facilitate an electronic scanning process.

• Use a phased approach - pilot an implementation in an area preferably not critical to core services. Obtain experience in implementing, training and monitoring the system then expand from there.

• Understand what you are trying to achieve through DIS - straight cash return on investment or more difficult to measure strategic gains (e.g., geographic expansion, improved customer service or quality of care). Some organizations have invested in DIS/workflow with the sole intent of improving customer service.

• Be flexible - the more end users begin to like the system, the more they will want to alter it or customize it to their needs. This may result in a implementation path which varies from original intentions.

• Take into consideration recent regulation - the conversion of a paper documents into electronic data with innovative workflows and accessibility may make the information subject to new legislative regulations (e.g., HIPAA - Transaction Code Sets or Privacy).

• Consider risk/reward models carefully - in contracting with a DIS vendor, incorporate careful milestones and risk/reward incentives into the legal agreement.

A paperless future is unlikely to happen anytime soon. The judicious use of document imaging technology can today offer cost, efficiency and resource conservation benefits to organizations that take the time to implement DIS in conjunction with carefully considered process and cultural change.

Cheryl Waggener is a client services executive for IT Optimizers, a business unit of Health Care Investment Visions LLC. Email info@itoptimizers.com.

 

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