Issue: January 2007

Toward a Paperless Environment

Exploring Web-based document management

By Dana Hinesly:

If you have seen one document management system, you have seen them all—right? Maybe not. The eLibrary Enterprise Suite from FileOn, Weston, Conn, takes a different approach to organizing the tons of paperwork flowing through hospitals each day.

"We are a software and services company, specializing in document management systems for health care enterprises," says Anowar Shahjahan, president and CEO of FileOn. "Our specialty comes from integrating HL7 with registration and health information management systems [HIMS], providing anywhere access to review, analyze, code, and complete electronic patient records."

FileOn's solution combines an intelligent automation engine with barcode recognition software. To begin the process, paper files can be entered into the system from any scanning device, regardless of manufacturer. This intentional feature is designed to limit the amount of new hardware that hospitals must purchase to use the software.

"Many vendors give scanners to hospitals for free, because otherwise, they can't sell their document solutions to them. But we decided not to build that part into the equation at all," Shahjahan says, explaining how this frees up facilities to maintain existing documentation workflow. "We go in and look at a facility's process, assisting with methodology and quality assurance, and then users can upload to the server from anywhere."

Anyone with permission to log on to the system can do so from anywhere they can go online—whether it is an intranet, extranet, or Internet connection. Exactly who can gain access is governed through secure identification code.

Compatible with existing HIMS', the eLibrary Enterprise Suite is a web-based software solution that, once installed, is virtually transparent to the users. Physicians, for example, log on to the hospital's network as usual. Behind the scenes, the Suite routes the physician through the HL7 integration into the existing HIM.

"The solution logs them in automatically, taking them directly to that particular patient's information," Shahjahan says. "It also ensures that the information is secure: They can't go anywhere else, except to that patient."

When users search for a patient, the system produces a list of documents by date, each of which is converted into a secure hyperlink. When selected, this link connects them to the related information. Images are stored as TIFF files and are converted to PDF files so that they can be opened using the free Adobe software already installed on many computer systems.

"When scanned, most images take up only 50kbs to 150kbs; therefore, 5GB can store as much as 70,000 images," Shahjahan explains. "For some customers, we have advised and provided NAS servers for as little as $3,000 with 500GB of Raid 5 storage, which is more than sufficient for most small to mid-sized customers.

"Additionally, upon agreement with customers, we often will get involved with the hardware sizing analysis and provide recommendations to the customer on the most cost-effective solutions in the market," he continues. "Also, we often can implement the hardware setup, connect it to the network, and install all of our software remotely and support it remotely. As far as we can tell, there is no limit to how much we can scale this. It's mostly dependent on the Windows operating system and Intel server performance."

All of this technology and access is simple to navigate. Users likely will notice a strong resemblance between FileOn's look and that of Microsoft's Internet Explorer. The similarity is not coincidental. Because Explorer is one of the most commonly used browsers, FileOn patterned its user interface to mirror many of its qualities.

"Doctors and hospitals are busy, and the last thing you want them to do is take time away from their work to learn another interface," Shahjahan notes. "Because the design for the patient information is very similar to Explorer, it further increases adoption because there's nothing new to learn. We've been training new users in about a minute."

Teaming Up

The eLibrary Enterprise Suite for health care organizations is a result of a close collaboration between FileOn and the team at Norwalk Hospital, Fairfield County, Conn, where the FileOn solution was installed in September.

"We would not have been able to do this successfully without the participation of Norwalk Hospital's staff. The quality assurance aspect of HL7 is so complex that without them, we would not have been able to be successful," Shahjahan says. "These are patient records, so we worked with them to make sure the HL7 integration was so tight that there would be no chance of error."

Marisa S. Barbieri, MS, is a senior software designer at Norwalk Hospital and founder of HospitalBarcoding.com; she was the project manager and the senior designer for the FileOn solution.

"[The FileOn software] was the backbone of an imaging tool," she says. "Using barcoding as the main vehicle for document recognition, we customized it for use in our domain."

Not only does the solution come complete with barcodes to identify 146 standard hospital forms, but FileOn's Suite also is compatible with any existing custom forms or documents that a hospital may have in use. A standard registry kit allows facilities to create labels for forms that come in from outside health care agencies, such as those accompanying patients who are transferred to a hospital from one outside the system. Barcode labels can be adhered anywhere on the form.

The medical records team at Norwalk was the first to put the system to use, working exclusively on documents from the emergency department (ED) as quality analysis reviews are being performed to ensure the system's performance. To date, Barbieri and her staff are very pleased. Eventually, staff in the ED will scan documents as the patient is processed.

"Releasing this product to the point of care area is a very new concept in hospitals today, but we want to disseminate the information to our caregivers as fast as possible," says Barbieri, who is a member of both the National Patient Safety Systems Committee of the Health Industry Business Communications Council (HIBCC) and the Bar Code Task Force of the Healthcare Information and Management Systems Society (HIMSS). "Barcodes have enabled us to do that, because if every document is encoded with [one], the document can identify itself and is electronically filed—as opposed to a manual intervention and review of the document with the human eye. And that is where you gain efficiencies."

Because it is currently used only in the records room, the hospital has not conducted a form analysis of the exact savings—in both time and money—that have resulted from FileOn's installation; however, anecdotal evidence indicates that the software has made a substantial impact already.

"Although I don't have a quantitative number, the efficiencies have risen dramatically—it's been amazing. In cases where it used to take days to get documents into the HIMS, it now takes minutes," Barbieri notes. "We've seen efficiencies in the medical records department: Before they had to manually intervene on every single document and index it, and now, they just scan it and it goes into the folder of the right patient."

Number-crunching aside, Norwalk Hospital has noted the impact that the solution has made on patient care—and the improved workflow and throughput that are a direct result of the solution.

"We want to make sure that the physicians have the most up-to-date information on the patient, and FileOn's solution disseminates the information days earlier than what we're used to," Barbieri says. "It improves patient care, and that's our bottom line here at Norwalk."

Dana Hinesly is a contributing writer for Imaging Economics. For more information, contact IEeditor@ascendmedia.com.