Curbside Consult with Dr. Jayne 5/31/11

Dr. Jayne Interviews KC Frank, EVP, Document Imaging Systems Corp.

KC Frank is executive vice president of Document Imaging Systems Corp. (DISC) of St. Louis, MO.

Give me some background about yourself and DISC.

DISC has been in business since 1958. Originally founded as a microfilm company, DISC has evolved into a document management solution provider focused on improving our client’s business processes. In 2007, DISC was acquired by The Flesh Company, a 98-year-old print solutions provider. I joined DISC as vice president in 2003 and have helped develop new solution offerings, strategic relationships in healthcare, and growth strategies. I am a long-time member of MGMA, AIIM, AIIM, ARMA, and TAWPI and recently received an AIIM Distinguished Service Award for accomplishments in the Information Management industry.

One of your marketing campaigns, which has been mentioned on HIStalk, is “No hybrid EMRs.” What do you mean by this?

A hybrid EMR is one where providers rely on both an electronic and paper chart post-EMR implementation. I have heard countless stories of physicians walking into encounter rooms with both a paper chart and a tablet PC. Managing patient care in a dual environment is both incredibly inefficient and frustrating. Without a solid strategy to eliminate the paper charts, the hybrid EMR will be a reality for physician groups as they migrate to EMR.

Many practices I talk to think they can scan their documents cheaper or better themselves. What’s your experience?

If organizations truly understood the process of conversion before starting, they would probably all outsource. About 50% of the clients we work with have tried to scan on their own first. Most organizations underestimate the time, difficulties and costs associated with converting their paper charts. It’s been proven many times over that a scanning process managed and executed by inexperienced staff results in double and sometimes triple the cost of outsourcing to an expert service provider.

It’s common sense. Businesses get better each time they execute a process. DISC has converted over a billion documents in our history. Physician groups may have never scanned a single chart when they start planning their implementation. Service providers like DISC are converting documents using technology designed for large batches of scanning, including scanners that cost in the hundreds of thousands of dollars. With better technology and processes built on experience, it’s difficult to imagine a healthcare organization that could scan cheaper and better.

How is working with outpatient medical practices different from working with a hospital, or say an academic medical center?

There are subtle differences such as project design, chart setup, document types, chart access needs, and workflows. Ultimately, with strong project management by the client and service provider, the differences are negligible.

Do you just work with local clients? What’s the farthest client or most exotic locale you’ve visited to convert charts?

We typically provide services on a regional basis. Since we are certified by both Allscripts and NextGen to provide services in the central region of the United States, the majority of our clients reside in an 18-state central region of the US. We’ve provided services as far west as California and as far east as North Carolina. Do they practice medicine in Hawaii? We’re still waiting for that call.

Thinking of some of your more difficult customers, what are some pieces of advice for practices preparing to convert from paper charts to an EHR?

First, decide on a conversion strategy. Will you outsource or attempt an in-house conversion? Will you scan all charts prior to go-live or scan by the schedule after go-live? Will you scan the entire chart or just a portion of the chart? All key strategic questions. Many times organizations lean on providers like DISC to help understand the pros and cons of each of the strategies.

Pick a strong project manager. Many times the HIM or medical records director is the right choice. Make sure the person you choose cares about the success of the project. Do not hire temp staff to manage the project.

If you choose to outsource, choose a partner that has experience with medical record conversion and the EMR you are migrating to. A service provider that doesn’t have experience with your EMR system may not be able to get the documents filed appropriately in that system.

If you plan to scan yourself, do time tests to determine how long it’ll take to scan a chart. This is critical. If an organization plans to scan by the schedule, meets with 200 patients per day, and can scan a chart in 20 minutes, it’s simple math to determine that it’ll take about 66 hours per day (8 FTEs) to keep up on that project. Don’t be caught off guard.

DISC does more than just scan old paper charts. What other solutions do practices need to manage the mountains of paper they’re used to moving? Will you go out of business when all the old charts are scanned?

If we relied solely on scanning historical charts, we would be out of business in five to seven years. Fortunately, we have developed other solutions in both document and content management to evolve with our clients. Although paper is slowly being eliminated from business processes, the volume of electronic documents and content continues to increase.

Today, we are offering solutions such as Daily Go-Forward Scanning, Revenue Cycle Document and Content Management, Accounts Payable Automation, Electronic ROI, and Business Intelligence. We also offer a variety of solutions in other vertical markets, including finance, manufacturing, education, and government. We plan on being around another 50 years.

Does it make a difference whether a scanning vendor partners with an EHR vendor?

Absolutely. Having intimate knowledge of the system the healthcare organization is implementing allows the scanning vendor to automatically load the electronic charts directly into the patient chart within the EMR. Without the auto load, healthcare organizations may be left with electronic charts stored and retrieved in a third-party system or internal network drive. This, of course, is not optimal since providers have to work within two systems to find charts instead of just the EMR.

Both Allscripts and NextGen realized the importance of this integration and put certified programs together to support their clients. DISC is a part of both of those programs.

You’re located in the Midwest, an area hit hard recently by floods and tornadoes. Any great “saves” with your clients during these disasters?

We actually did have a client this year ask us to scan hundreds of boxes of records stored in the first level of their building due to flood concerns. Unfortunately, natural disasters have a history of reducing the historical content of a business to rubble; specifically all the important documentation which resides in a paper format. Fortunately, companies like DISC can digitize that critical information so disaster recovery of those documents is as simple as reloading a backup.

Any final thoughts?

Another common strategic discussion we have with clients is whether or not they should scan the entire chart or just a portion. We have seen successful projects on both ends. Understand that the benefits many organizations expect when going to an EMR, such as eliminating chart filing labor costs and reusing paper chart storage space for revenue-generating opportunities, will not be realized until the entire chart can be removed from the chart room. This decision is typically made with one of two goals in mind – to satisfy clinical needs (partial scan) or to satisfy business needs (full scan).

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