Sentara Healthcare

A key challenge for healthcare providers is processing and assimilating unstructured clinical data for patient care and billing. Sentara Healthcare, a large not-for-profit health system serving Virginia and North Carolina, has made use of OnBase Express Scanning, Forms Management, and Workflow to automate labor-intensive clinical, administrative, and financial processes, thereby improving staff productivity, patient care decisions, and reimbursement.

Taming the clinical paper tiger

Paper records presented by new patients pile up quickly in HIM departments. Ensuring speedy access to patient history is critical for improving care decisions. HIMSS has established 24 hours as the core quality standard required for integration of records within the patient’s EMR for EMRAM Stage 7.

Given hundreds of sites for care across 12 hospitals, Sentara Healthcare had both complexity and diversity in the types of documents received from patients. The scanning tool that Sentara Healthcare utilized to capture patient records did not meet staff needs. It was unreliable in getting documents to their Epic EMR or OnBase content services platform. The origin of scanned documents was unknown. There was no ability to add document types or descriptors and the sweep process for scanning sometimes failed to work.

“We wanted to make it easier for folks to do their job and meet our service line requirement to move paper documents into the patient’s EMR within 30 minutes of receipt,” said Tara Neitzel, IT operations manager.

Sentara Healthcare worked with Hyland to configure their master and local configurations and set up icons giving staff in more than 600 locations the ability to simply click a button to select a document type and descriptor, prior to scanning and importing it to OnBase for direct access within their Epic EMR.

OnBase Express Scanning technology allows an administrator to configure the capture of unstructured patient documents to meet the needs of each department and location.

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Neitzel says that “setting up a new facility is simple and the maintenance is low after the build is complete. If there is a problem with any scans, the support team can quickly identify the location for follow-up.”

“I tell clinicians this is the easiest thing you are going to learn,” Neitzel said.

“The clinician or administrative staff clicks on the document type and the Epic description from a drop-down menu and then scans to import ad hoc or batch files into OnBase. Express Scanning provides the option for selected departments to add additional text descriptors. Each document is barcoded, ensuring the HIM department has all the patient information and Epic description on receipt.

According to Neitzel, “We are now indexing in 0.28 seconds. Express Scanning has exploded; we have it deployed at 650 to 700 scanning locations throughout our enterprise. This technology dramatically reduces work for the HIM staff and frees more time for quality assurance. We now have 97% of documents in patient records in under 5 minutes, this is an 83% improvement over our 30-minute service line agreement.”

“We are leveraging OnBase Express Scanning across our organization and within many departments,” Neitzel said. For example:

• Express Scanning is used as a communication route for infusion centers with external providers and the infusion pharmacy then the orders are integrated back into Epic.
• Materials Management staff are using it for easy retrieval of packing slips that have been expressly scanned on package arrival.
• Reference Lab staff are using it for bar-code requisition scanning upon specimen arrival expediting claims processing for billers.
• Hospital and Professional Billing take advantage of this solution to route fully indexed correspondence, financial assistance documentation, and attorney requests to appropriate staff based on rules that establish balanced work queues

The telemetry workflow has been enhanced at seven different sites by allowing for the scanning of multiple documents for multiple patients at one time. This effectively increased efficiency for both telemetry staff and the HIM staff who index these documents.

Sentara Healthcare has applied reengineering and Lean techniques to remove non-value-added steps and their team has made use of OnBase Express Scanning technology to automate, streamline and accelerate document workflow management and tracking. Ultimately the process improvements have touched every Sentara Healthcare employee and have resulted in significant cost savings and cost avoidance projected at more than $2.5 million.

In addition to Express Scanning, Sentara Healthcare actively utilizes OnBase technology across its organization in a variety of departments. Here are some additional examples:

Health information management

Preventing missing charges

Missing or inaccurate measurement of observation hours, especially for infusion administration, is one of the most frequent causes of lost revenue. Sentara Healthcare was able to leverage their existing OnBase e-form technology toolkit and workflow routing to provide an easy-to-use solution.

“We are auto-filling our observation form for infusion and injection administration and bedside procedures based on patient identifiers and it is calculating the billing data, based on the number of hours, so we are accurately paid for observation visits,” Neitzel said.

Patient access

Moving to paperless processing for centralized scheduling and authorization management

Sentara Healthcare was able to move referral authorization management workflow for 39,000 faxes received per month from paper to electronic with OnBase. Orders are now easily received, indexed, routed for faster authorization management, tracked and stored within OnBase and integrated with Epic. This leads to improved efficiency and reduces the cost of operations. Integration with auto-dialer technology also lets patients know they are ready for scheduling.

Patient registration support

OnBase integration with Epic allows registrars to electronically capture a patient’s signature on arrival and scan insurance cards and photo ID’s utilizing Front Office Scanning.

Clinical

External lab, imaging and cardiac orders – electronic filing of faxed orders

Sentara Healthcare uses OnBase to provide for centralized capture and storage of faxed lab, imaging and cardiac orders for providers across the region. Integration with external lab software and a simple custom query enables orders to be easily located, reducing patient delays.

Pre-admission surgical screening

OnBase has simplified management of pre-admission surgical screening documents sent from external practices. Documents are indexed within OnBase, sent to Epic via HL7 and a provider communication is logged and retained.

Patient results received externally are integrated within the EMR

PDF results received from external software systems, such as pulmonary, cardiac, and gastrointestinal applications are routed and sent for workflow via OnBase and then integrated within Epic.

Processing of survivorship care plans

To comply with requirements enacted by the Commission on Cancer, Sentara Healthcare has utilized OnBase e-forms to collect patient information for a variety of cancer survivor care plans based on the type of cancer. Forms are imported and routed for completion within a variety of practice systems, and then integrated with Epic.

OnBase mobile integration with Rover for home health and hospice

The mobile integration with Epic Rover® allows Sentara Healthcare field clinicians to provide more than 20 electronic forms to homecare patients. The forms can be easily completed and signed within the application allowing for secure upload to the patient’s EMR.

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