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Scanning
system improves record handling
by Tamara Pomerantz, Systems Analyst, CCIT,
and Donna Padgette, R.N., Program Nurse Specialist,
Hospital Computer Services
A thousand medical charts on the shelf, a thousand medical charts;
take one down, pass it around....still too many to go!
That could have been the chart completion theme song at MUSC, but no
more.
 Dr.
William T. Adamson, Pediatric Surgery, completes records online.
During the months of April, May, and June, 1,072 medical record documents
were signed electronically using the On-Line Chart Completion (OCC) system.
That's 1,072 charts that did not have to be located, pulled, and delivered
to a clinician's office. Furthermore, all the other people
needing the chart didn't have to wait for the clinician to finish with
it before they could access it, and charts were completed weeks faster
than traditional paper charts would have been.
OCC, which provides electronic chart viewing and signing, complements
the “OmniVision” program, which just provides chart viewing; both programs
are part of a system from LanVision which the Emerald Project is using
as the document imaging portion of MUSC's electronic medical record solution.
Overseen by the Emerald Project's Document Imaging Project Steering
Committee, teams from the Center for Computing and Information Technology
(CCIT) and Health Information Services (HIS) have been working on the LanVision
system (purchasing, installation, configuration, training, roll-out) for
the last four years. The Hollings Cancer Center began using OmniVision
about a year ago, and since then its use has spread to other MUSC areas
such as the Emergency Department, Ob/Gyn, and Pediatrics. Plans for rolling
out OmniVision and OCC to the rest of the clinical enterprise are being
developed.
Clinicians and others in the cancer center and the 8-West and 10-East
inpatient oncology units began using OCC in January. Now, hematology/oncology
and pediatric resident and attending physicians are completing charts online.
Unlike the past, when residents' dictations generally went straight
to the attending physicians for corrections and signatures, residents now
get a chance to see and correct their own dictations before the reports
go to the attendings for final signatures.
An additional benefit is the improved communication between clinicians
and Health Information Services (HIS).
HIS can inform the clinician more quickly about a chart’s “deficiencies”
—the items in the chart that have to be completed before the entire chart
is considered to be complete. Clinicians can respond to alerts or deficiencies
and can send comments to HIS analysts if there's a problem. No one using
OmniVision or OCC has to wait for a chart. Any number of people can review,
sign, process, and work with the chart at the same time. Also, HIS can
fax documents directly from the system to referring clinicians.
When a patient's encounter (inpatient or outpatient) is ended, an HIS
analyst reviews the required elements of the patient's medical record to
make sure all documentation is complete. If a document is missing, the
analyst assigns a dictation notice to the appropriate clinician. If signatures
or data are missing, the analyst notifies the physician regarding the needed
components. The OCC system automates this process for HIS, alerting them
when charts need review, flagging key documents and elements to look for,
and sending an alert or chart deficiency notification to the appropriate
clinician.
Kathy Borrero, HIS chart completion analyst, is a regular OCC user
in her position and attests to its benefits. “OCC has made my job easier
by having access to the medical record right away. I log on to my computer
every morning and my work is right there. At the same time I am analyzing
a chart, someone else can be viewing it, coding it, or using it for patient
care,” explains Borrero.
One of the most significant benefits from the OCC system is that it
helps improve the patient care enterprise's cash flow. On average, 10 to
15 people need to “lay hands” on a chart before it is considered complete
and a bill can be issued. Before OCC, only one person at a time could use
a given chart; sometimes bills didn't get issued until many weeks after
discharge.
Now, with OCC, everybody can be working on the chart at the same time,
allowing completion of the chart review and billing process much earlier
than before. HIS manager Christine Lewis states, “OCC helps me find the
documentation needed for prompt and accurate billing without the physical
effort of locating the medical record and manually searching through it,
then refiling it. I can also quickly research what hasn't been coded so
that the bill goes out as soon as possible. This creates better patient
satisfaction and improves cash flow for the hospital.”
While OmniVision and OCC certainly make medical record review and completion
here on the MUSC campus more convenient, the most recent development even
makes it possible for the clinician to do this chartwork when away from
MUSC—at home, for example.
Omnivision and OCC are now accessible via the Web, whether on campus
or not. Omnivision and OCC users who have access to CCIT’s “WebApps”
server (which provides access to Oacis and many other applications through
the web) can call the CCIT Help Desk (792-9700) to request that the icons
for Omnivision and OCC be added to their WebApps menus. The WebApps server
is a HCFA-compliant, secure server, so it's legal for clinicians to access
it from third party Internet service providers such as cable modem and
DSL (Digital Subscriber Line) connections. Early users have been surprised
to find that the speed with which the screens pop up at home is virtually
indistinguishable from the on-campus experience.
“OCC and OmniVision accessed via Webapps are like a ‘shot in the arm’
which will help in timely completion of medical records, keeping me off
the delinquency list and allowing me access to medical records without
delay,” said Dilip Purohit, M.D., professor of pediatrics and Neonatology
Division director, who has used the LanVision system.
In any medical record system, the ability to protect patient confidentiality
is very important.
All OCC and Omnivision users sign Security and Confidentiality Statements
before they are issued their personal access codes, and all accesses are
recorded in a log. Audit trail reviews are used to determine inappropriate
accesses. Additionally, the WebApps server automatically encrypts transmissions
when these systems are being accessed via the Web, so patient information
stays confidential online.
It's also important that users be familiar with the system's capabilities.
HIS provides each user a brief training session at the time the user is
given his or her access codes to the system.
CCIT is also developing a link between the Oacis and LanVision systems.
An icon will appear in Oacis windows any place where Oacis is displaying
information for which an associated document exists in the LanVision system.
Clicking on the icon in Oacis will automatically bring up OmniVision
and display the scanned document. CCIT hopes to have this new linkage in
operation next year.
OCC and OmniVision fulfill a multitude of needs across the healthcare
spectrum, from clinical to administrative support with the added bonus
of assisting with regulatory compliance.
For more information on these systems, check out the web sites shown
below or contact the Document Imaging Project Steering Committee: chairman
Steve McLeod-Bryant, M.D., Psychiatry, mcleodbs@musc.edu; CCIT project
manager Tamara Pomerantz, pomeratn@musc.edu; or HIS imaging supervisor
Tom Holley, holleyt@musc.edu.
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