UT Southwestern Medical Center at Dallas
One of the country's leading academic medical centers, patient care providers and research institutions, the University of Texas Southwestern Medical Center operates two university-owned hospital buildings and more than 70 ambulatory clinics at its geographically dispersed Dallas campus. In its ambulatory clinics, UT Southwestern implemented Epic Systems Corp.’s scheduling, registration and electronic medical record applications to improve patient care and satisfaction and to facilitate sharing of health information among caregivers.
However, the university clinics were still utilizing resources to route and file remaining paper documents such as copies of patient consent forms and clinical records from other facilities. In addition, the hospital buildings’ admission areas were in need of document scanning to reduce costs of copying, routing and storing patient information. The Transplant Service Center also needed to reduce storage space dedicated to donor files and create secure, easily accessible files.
To complement its enterprise applications, UT Southwestern searched for a document management solution that would support batch scanning, distributed scanning, COLD/ERM and records management. Experience in integration with Siemens and Epic were also requirements. Following a formal RFP process, client interviews and onsite visits to other hospitals, UT Southwestern chose Hyland Software’s OnBase enterprise content management (ECM) software for its integration capability and ease of administration.
“Initially, we were specifically looking for a solution to supplement Epic for the ambulatory clinics,” recalls Tim Leary of the Information Resources Clinical Information Services Division at UT Southwestern. “Where Hyland really stood out was its strong expertise in the healthcare vertical and its experience with Epic and Siemens integrations.” The scope of the project has expanded beyond the clinics to more than 100 patient registration sites, including main admissions at the 300-bed St. Paul Hospital and 152-bed Zale Lipshy Hospital. In the hospital buildings, 200 concurrent users access OnBase to research patient information and EOBs and perform other tasks.
In the ambulatory clinics, Epic Prelude is being used to collect patient demographic and insurance information. The scanning integration with Prelude includes scanning of patient IDs, consent forms, insurance cards and other pertinent registration information. Once scanned using fi-5120C document scanners from Fujitsu Computer Products of America, the images of the documents are linked to the patient record in Epic Prelude and can be easily retrieved and viewed by authorized personnel throughout the campus. The convenience of having scanners at their desks saves time for Registration personnel who previously had to leave their desks to photocopy patient insurance cards and consent forms.
“One of our primary objectives was to share these documents across multiple sites to reduce manual labor and increase patient safety,” Leary notes. “The campus covers several square miles and clinics are divided by specialty practice. A patient might initially register in a primary care clinic and then be referred to a UT Southwestern specialty practice clinic. With OnBase, documents are immediately accessible across clinics; there is no need to scan redundant copies of HIPAA forms, consents for treatment, etc. Prior to using OnBase, the patient would have a paper chart, which could be delivered from one location to another. But if the appointments were closely booked (same day or next day), the paper documents may not be filed to the paper chart in time for the second visit. This resulted in inconveniencing the patient to sign the forms again and present an insurance card a second time.”
EpicCare, the electronic medical record (EMR), is being deployed across the ambulatory clinics at UT Southwestern. Patient documents, which previously had to be kept in paper files, are now incorporated into the patient’s EMR. Most of the clinical documentation is input by clinicians directly into EpicCare. However, using the Epic integration interface, OnBase is used to capture forms such as patient-completed health questionnaires and outside or external medical records.
Many faculty physicians may only have clinic hours one or two days a week. Prior to OnBase, if a paper-based laboratory report from an external facility arrived in a clinic, that doctor may not have been able to review the results until the next time they had clinic hours. Now documents such as these are scanned to an Epic Order as they come into the clinic, and the Epic application automatically sends an In-Basket message to the physician. The physician can view the scanned document right from a hypertext link embedded in the Epic message from a workstation anywhere on campus, such as their academic office.
The two hospital buildings, UT Southwestern University Hospital-St. Paul and UT Southwestern University Hospital-Zale Lipshy, utilize Siemens OAS/Gold as their admission and billing systems. In order to make collection of patient information more accurate and improve availability of necessary insurance and other patient billing information, OnBase was integrated with OAS/Gold.
This integration is supported by OnBase Desktop Scanning with an automatic indexing feature to assure accurate indexing for the admission documents in the hospitals. The information collected at Admissions has a direct correlation to the effectiveness of the billing and collections department and significantly reduces the inefficiencies associated with copying and routing of paper documents.
In addition to scanned documents, COLD/ERM is used to collect electronic files, like registration face sheets, that are not stored permanently in Siemens. This process provides historical information on each patient for collectors. Onsite collectors use the OnBase thick client integrated with OAS/Gold. For easy document lookup of a patient’s billing records, a customized retrieval button in the Siemens application triggers a message to OnBase that returns a hit list of documents relating to the patient account that is being viewed. Collectors also use Virtual Print Driver to store outgoing letters and other documents related to patients simply by “printing” the document directly to OnBase.
The improvements to patient service and satisfaction are complemented by improvements in revenue cycle management. Because patient documents needed for billing and collections are immediately available from line-of-business applications, they can be easily accessed for research purposes. “In the past, if someone needed documents for billing a collections appeal or insurance referral authorization, they may have had to request a chart located in a facility a couple of miles across campus,” says Leary. “Because it’s paper, there was delay in receiving the paper documents. In addition, the departments incurred courier costs for the document delivery. There’s also the vulnerability of having only one copy of the paper. Our OnBase system provides redundancy for the information and eliminates the delays and costs of courier service.”
In addition to registration and clinical documents, paper EOBs are scanned using a fi-5750C from Fujitsu. Bar codes are used to divide batches into individual documents for indexing. OnBase AutoFill Keyword Sets are collected from Siemens OAS/Gold via an HL7 interface to automatically index documents without human intervention.
As the number of electronic transactions increases in Patient Accounting, UT Southwestern can accommodate them within OnBase. Electronic EOBs are being imported into the OnBase system using the EDI 835 Processor. The data contained in this electronic exchange can be applied to a user-friendly template for easy viewing.
“It’s hard to quantify the dollar value of better access to documents needed for billing and collections,” Leary observes. “But it certainly helps us increase revenue, makes us much more efficient and improves job satisfaction for Admissions and Patient Financial Services staff.”
Recently UT Southwestern began using OnBase Workflow to automate specific tasks and processes, making them easier to track and monitor and reducing labor. For instance, when the hospitals receive an insurance authorization for admission so far in advance that an encounter number hasn’t been generated, the workflow process automatically stores it and makes it possible to link the authorization to the patient record later.
Workflow is in the process of being implemented with in conjunction with a Captaris RightFax solution in the “bed board” process. When a patient is assigned to a bed or transferred from one type of bed to another, the bed change order is faxed to schedulers. The faxes are captured electronically, indexed and then routed into a workflow queue from which schedulers can retrieve them to perform insurance verifications regarding the changed level of care.
UT Southwestern is also a regional donor center for bone and tissue transplants. The Transplant Services Department uses OnBase to store the donor records. Similar to a medical chart, this record includes information about the donor, family consent forms and any microbiology or pathology tests. Making the records associated with bone, skin, tissue and cornea donations available electronically facilitates the various levels of review and approval required by the FDA.
By eliminating the repetition of collecting patient information and secure sharing of electronic documentation, OnBase supports UT Southwestern’s goals to provide innovative and compassionate healthcare. Integration with existing enterprise systems makes it possible to reach those goals without excessive disruption to patients, employees, clinicians or IT staff.
- Integration with Epic completes the fully electronic medical record
- Eliminates redundant collection of patient documents
- Makes important patient care information available quickly to multiple caregivers
- Improves access to patient records for a remote and mobile clinical staff
- Supports research for Patient Financial Services, increasing productivity and cash flow
- Reduces risks and costs associated with managing and transporting paper documents
- Facilitates complex recordkeeping and audits associated with Transplant Services
- Epic Systems Corp. EpicCare® and Prelude®
- Siemens AG OAS/Gold
- Fujitsu Computer Products of America document scanners