With our electronic document management system (EDMS) project underway, this month we focused on creating a formal project plan with schedules, timelines and deliverables. This document included our strategic goals, objectives, priorities and a complete implementation summary. Within the summary, specific tasks, dates and responsibilities were defined. As you can imagine, this is no small document! Even for a 25-bed critical access hospital.

Dear diary, deadlines and deliverables! I guess we really are moving forward. Our new EDMS partner (SDS, formerly Smart Document Solutions) helped us lay out the next several months taking into consideration our goals and priorities. We identified three phases and priorities within each phase:

Phase One: HIM and the Meditech ADT interface

Phase Two: Business Office

Phase Three: Other Departments and additional interfaces

This month we focused on Phase One: HIM. And within Phase One, our top priority was getting the emergency department (ED) records online. Once we have ED up and running, we will proceed with same day surgery and then inpatient record types. Our plan calls for Phase One to take approximately 6 months from beginning to end.

Fast and Furious in the ED
Like many EDMS implementations, we started with the ED. We saw several benefits of starting in this department including:

·         Fewer forms and smaller records

·         Gives quick "win" for a wide variety of users

·         Saves staff time in HIM

·         Incentive for ED physicians to use new documentation forms

As mentioned last month, we had already evaluated our ED records and identified only one document type that would need to be indexed separately: EKG tracings. ED medical records at North Valley are about five pages in length, so these charts provided our prep, scanning, indexing and quality assurance staff with a manageable goal.

Secondly, by bringing ED records online we provided a quick win to multiple users - all at the same time! Every Monday morning, ED charts are the most-requested documents in our department. Clinics and primary care providers need this information as patients return for follow-ups after weekend visits to our ED. By having ED records online, physicians can access information online and if necessary, HIM staff can pull up records electronically and fax to physician office staff or other requestors. This quick win really improved customer satisfaction and reduced time spent chasing documents and pulling records in HIM.

Finally, the ED physicians had been asked to postpone the use of new, manual documentation forms until scanning was available. Now it was!

Staffing Issues: Balancing Workload With Progress
One of the biggest challenges with EDMS implementations is how to keep up with current workloads while also learning and installing a new system. With such a small department, we did not have the ability to hire additional staff or outsource the day-to-day operations. Instead, we re-assigned and cross trained staff. Also, with the implementation of new clinical documentation forms in the ED, fewer dictations were performed, which freed up some MT time to provide back-up coverage for others within HIM.

With records online, our primary file clerk was reassigned to lead scan technician. She was given a new job title and job description. Our record analysts were cross-trained to provide back-up and asked to prep records as they analyzed the charts. As such, the analysts' job descriptions were also updated.

Let the Scanning Begin!
The first week was spent with on-site scanner and HealthPort® training. We practiced prepping and scanning records. At the same time, we trained ED users on how to find and view records within HealthPort. The second week was focused on actually scanning live ED records into the system. We ironed out several workflow issues between ED and HIM during this time. By the end of the second week, we were live with ED records in our new EDMS.

Since our admission, discharge and transfer (ADT) interface with Meditech was not installed yet, SDS worked with our IT department to create a daily output report of all registration information. The report was automatically uploaded into our EDMS at the same time every night. This helped reduce manual entry and data entry errors during scanning.

Lessons Learned
We learned several lessons this month and they all had to do with time management and expectations!

First and foremost, we learned that more time was needed for testing. I suppose this is true for every EDMS implementation. It's a real struggle to manage staff time for testing and have a clean implementation. There just isn't enough time when you are also trying to keep up with the day-to-day functions within an HIM department. We had to skimp on testing which caused a large amount of re-scanning and re-work.

My advice is to dedicate as much staff time as possible to system testing. One solution is to temporarily outsource some of the day-to-day functions during this transition period. If you can afford to do so, it is a great idea.

The second lesson we learned was that less manual interaction is better. To get up and running quickly, we decided to use barcode stickers and manually apply them to our ED charts. This helped us get up and running quickly, but the stickers provided more of a chance for error because it was a manual step. For example, missing a sticker on a lead ED record caused it to not separate from the following chart and get filed incorrectly. About a month later, we started printing barcodes on the ED encounter form using a Meditech system utility. This saved a lot of time and electronic misfiling in HIM.

Finally, in our initial project plan, we gave ourselves plenty of time between phases. In fact, we planned for a 4-month window between our ED implementation and our next step-same day surgery. Having a lot of time in between phases is a breath of fresh air! And it gave us time to celebrate our success!

ED physicians, their office staffs and affiliated clinics are already spreading the word about how fast and easy it is to view medical records in HealthPort. The medical staff is excited about future phases and hospital administration is thrilled with the high levels of customer satisfaction we've already achieved.

Next month, we'll tackle our second Phase I priority-same-day surgery records.

Traci Waugh is director of health information and compliance at North Valley Hospital, Whitefish, MT, and a client of SDS.