Although many hospitals today consider themselves "paperless" in one or more areas of care, making a commitment to eliminating paper records entirely throughout the enterprise can be a frightening and difficult venture. Operating a 250-bed acute care hospital that serves six communities across Illinois, BroMenn Healthcare (Bloomington, IL) is one organization that has taken that leap with MEDITECH's Scanning and Archiving product, and has done so with remarkable success. By having all physicians submit and sign charts electronically, making records more current and complete, and providing system-wide access to charts, BroMenn took a gamble that paid off handsomely in increased patient and physician satisfaction, as well as reduced hospital expenditures.

"As an early adopter of Scanning and Archiving, we saw our mission to go paperless as a means to provide our staff with immediate access to patient records, while curbing the cost and resources required to maintain paper records," says Kathy Davis, vice president and chief information officer at BroMenn. "Our vision was to provide a single point of data entry for physicians and clinicians, and we were able to do so by scanning in the non-automated portions of the record. Fortunately, MEDITECH was a great partner in helping us achieve this vision."

Confronting Past Problems and Preparing for the Future
One of the biggest problems of maintaining a manual record-keeping system involves producing and managing the sheer volume of paper necessary to keep the hospital running. Prior to implementing Scanning and Archiving, BroMenn Healthcare generated, on average, 189,000 pages per month in patient charts alone. Several full-time employees were required just to keep up with the filing and retrieval of patient charts. There was also a lack of consistency in forms throughout the organization.

"Two years prior to implementing Scanning and Archiving, our Forms Committee came together to review the more than 550 forms we were using and reduce that number to 300," reports Dave Harper, director of information systems for BroMenn. "Keeping the number of forms from growing, cutting the amount of personnel time required to handle the paper, and reducing the growing storage demands posed by a paper system were strong motivations for us to push forward the conversion to a fully paperless system."

As with any large-scale change, Harper cites the importance of planning ahead for potential challenges that may arise. "There was a lot of manual chart and form work that needed to be addressed up-front, even though the amount of manual involvement in record-keeping was greatly reduced," explains Harper. "We also had to take our backup processes into account. We've been able to greatly improve backup timing by placing the Scanning and Archiving application on its own backup system." Harper also stresses the importance of evaluating all staff processes prior to implementation, to ensure that staff skill sets can properly adjust to performing all processes electronically.

Getting Physicians on Board for a Smooth Implementation
Several steps were taken to prepare for the smooth implementation of this new system. A review of all current state and federal statutes was conducted to ensure that when the electronic records later became legal records, they would be in compliance with all state and federal laws. In addition, the hospital's storage area network (SAN) was upgraded in preparation for the coming increase in data storage requirements. "We also reviewed our Health Information Management workflows, as well as all job descriptions and job skills currently required to handle the paper files, to see how those workflows could be expected to change once the paperless system was in place," says Harper.

The next step in preparing for the transition was to educate hospital employees. "Constant communication was key to the project's success," states Harper. "From the beginning, we sent out a clear message to all staff that 100% compliance would be required. All physicians were expected to access their patients' information via the Enterprise Medical Record and to sign all charts electronically."

While many health care organizations cite physician acceptance amongst the greatest challenges of migrating to a paperless system, BroMenn's experience was quite the contrary. According to Harper, physicians approached the learning process with the same sense of teamwork, collaboration, and communication as everyone else.

"Our philosophy with training physicians was one-on-one. Wherever they wanted to be, we came to them to review their workflow processes in their environment," says Harper. This method of training produced great results, according to Davis, who says the organization now boasts 100% compliance of e-Signature for physicians. "We even have physician office staff using the MEDITECH EMR to access information, eliminating the need for our medical records staff to fax records to the physician offices," she says.

Success Means Saving Time and Money
But has BroMenn's hard work been worth it? The numbers speak for themselves: since eliminating the paper chart, BroMenn reports a savings of $10,000 annually. "By eliminating the mass storage of paper records, we've been able to conserve both storage space as well as the resource hours required to file and maintain paper records," says Davis, who was also impressed with the time regained across departments by having all data available electronically.

"I cannot even tell you how many times we used to search and search for paper charts," she says. "Now, we don't have to. We're saving hours upon hours of HIM staff time, and our chart processing time has come down from 2-3 weeks to only 3-4 days. Our nurses have also realized significant time savings, as they're now spending less time completing forms and more time on direct patient care."

The rewards are not lost on BroMenn's physicians either, as Davis reports they are thrilled to be free of the burden of tracking down their patients' paper records. Now, charts can be viewed simultaneously by multiple clinicians, so physicians are no longer required to wait for charts that are being reviewed by another department or physician.

"We streamlined the workflow for physicians so that they would only need to launch the EMR to access data. Now, the only reason they would ever have to come to the incomplete records room would be to get a cup of coffee," she says. "MEDITECH even helped us redesign the physician sign queue to make it easier for them. These factors combined helped us to drop our non-compliance rate to an impressive 2%, which is even better than we had hoped for."

Embracing a Paperless Future
Following their success with the first phase of Scanning and Archiving, BroMenn Healthcare is already planning to take the next steps to bring this technology LIVE in other areas of the enterprise. "We're planning to implement Scanning and Archiving across our remaining locations, including our Critical Care Hospital," states Davis. "We're also addressing the issue of planned and unplanned downtime by installing a remote redundant data center, which we expect will meet the physicians' expectations of zero downtime."

With their vision now realized, Davis hopes that more hospitals follow their example and take the plunge to embrace a paperless future. "Electronic records are the way to go, both from a workflow standpoint and a financial standpoint," says Davis. "As a Vice President as well as a Corporate Compliance Officer, I'm comfortable saying that our electronic record is our legal record, and our chart is now more secure in e-format than it ever was on paper."