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Offering Solutions to Hospitals can Create a Healthy Dealership

15 Apr, 2005 By: Darrell Amy imageSource

Offering Solutions to Hospitals can Create a Healthy Dealership

For nearly three decades, J&H Office Equipment served the
practical office equipment needs of Bozeman, Montana’s local healthcare
facility, the 85-bed Bozeman Deaconess Hospital. Over the years, however, the
medical needs of the community began to grow, forcing the hospital, which serves
85,000 people in a 90-mile radius, to increase its services and expand. Part of
that expansion included opening a separate outpatient laboratory across the
other side of town.

After years of using a paper-based filing system for patient
records, hospital administration came to the realization that a technology-based
system would need to be put into place. Bozeman Deaconess Hospital approached
J&H to explore ideas to streamline the flow of documents in its lab department.

"The challenge was when a patient arrived at one of the lab
locations, the staff at the lab had to review the physicians’ orders for the lab
tests," explained Steve Scharmann, the hospital’s business office manager. "In
many cases, these orders were not at the lab location and had to be retrieved
from one of the other labs."

Physicians’ orders, which are similar to drug prescriptions,
are written by doctors during rounds when they visit the hospital’s patients.
Many times, an order was at another lab. Due to Bozeman Deaconess’ outdated
paper-based system, the physicians’ orders were gathered by a courier during
rounds and delivered to one of the lab locations. In some cases, remote clinics
faxed the orders to one of the lab locations.

To solve the dilemma, J&H provided the hospital with DocuWare
(www.docuware.com) integrated document management software, eight Canon MFPs and
10 Fujitsu scanners.

"Before DocuWare came along, we had three sites that were
always on the phone with each other asking for copies of the physicians’
orders," recalled Scharmann. "Then, they would have to wait for it to be faxed
over. In our out patient services department, we’d go through our files and
would be unable to find a document. Then, we’d call the lab and they would stop
and rifle through their stack of documents. Finally, they’d find it and then we
would wait for a fax."

The Solution

To get an understanding of what type of solution the healthcare facility would
need, representatives from J&H decided to do a walk through of the hospital
campus and interview everyone involved in the process.

"We wanted to get an idea as to how their jobs would be
affected, and we wanted to know if they were generally in favor or against the
idea," explained J&H Vice President Tom Plumb. "For the most part, the employees
thought that it would be more work for them, but better for the hospital in
general if the images were stored in a central location."

J&H eventually won a competitive bid for the job and began
the three-month implementation process, which consisted of a single day for the
actual installation of DocuWare software and three months to train hospital

"Many of the users had never used a computer with the
Microsoft Windows operating system," said Plumb, whose company completed the
implementation in January 2002. "So we held training classes and the hospital
training center held classes on Windows and DocuWare to get them up to speed."

The dealership implemented DocuWare to streamline the flow of
information between the lab locations. As physicians’ orders were received by
the labs, they were scanned in batches to a DocuWare cabinet. Using an automated
indexing option, the orders were indexed by date and patient name.

Index fields enable information to be retrieved quickly.
Documents were scanned using a cover sheet printed from Meditech, the hospital’s
patient accounting system. The cover sheet has a barcode with an account number.
DocuWare then synchronizes with the Meditech system to populate the following
index fields:


Date of Birth

Social Security Number


Order Status

Order Expiration Date

Medical Record Number

Meditech Account Number

Service Date

Document Type: Lab, XRay, PT Order, Op Notes, Insurance Card, ABN, Surgery, PT

Status: Active, Filed, No Show

Special Instructions (Text memo field)

Patient Specific Notes

Now, when one of the labs needs to find a physician’s order,
it can be found in the DocuWare system instantly, which strengthens the core
business of any hospital—patient care.

"Our goal is to have a patient admitted and back into the lab
within ten minutes," Scharmann said. "That is easily attained now. Before, when
we were hunting for orders, we were over ten minutes on average."

Plumb explained that during the implementation process, they
figured out a way to make the application even more useful. Some of the patients
had a standing order from their doctor—meaning the doctor had required a patient
to visit the lab multiple times for tests over a given time frame.

"Before we came in, each lab had a rolodex file to track the
standing orders," Plumb explained. "The problem is that the rolodexes in each of
the offices would get out of sync very quickly."

J&H solved the problem by writing a small database
application that created a central database of standing orders.

"By searching this database, the labs can now make sure that
the patients come in for each of the multiple lab tests," Scharmann said. "This
ensures they don’t miss any of the scheduled tests. And for some, it makes sure
they don’t come in too often."

As most know, HIPAA (www.hipaa.org) (Health Insurance
Portability and Accountability Act) always needs to be taken into account when
working with a hospital.

"Organizations must comply with the HIPAA regulations and
software can help them accomplish that goal," says Plumb.

Other Applications

As the hospital explored the solution for the lab department, the administrators
began envisioning other uses for DocuWare in the hospital. Eventually, what
began as a solution for the lab department grew to streamline workflow in the
admissions, business and medical records departments.

Admissions Department--The admissions process is
document intensive. When a patient enters the department, they are asked for a
copy of their insurance card. This contains vital information on the patient. It
also includes contact numbers for preauthorization of payment on medical
services by the insurance company.

While the patient is at the hospital, multiple people need
access to the insurance card. Before DocuWare, the patient was asked for their
insurance card by each department.

"Having the card available in DocuWare keeps us from having
to ask the patient over and over again for their insurance card," Scharmann
said. "This restructures the patient’s experience and reduces frustration."

During the admissions process, the patients also sign several
important documents, including a consent for treatment form. Medicare patients
also have to sign an Advanced Beneficiary Notice (ABN).

The patient accounting software in admissions generated a
cover sheet for patient files. This cover sheet included a barcode of the
patient ID number.

"We found that we could use the visit number barcode on the
face sheet to automatically index the patient file," explained Plumb. "The face
sheet is placed on top of the consent for treatment and ABN form. The documents
are then scanned into DocuWare. The Auto Index module of DocuWare matches the
data coming from the patient accounting system with the visit number on the face

Every two hours the DocuWare system synchronizes with the
patient accounting system. The patient ID number from the cover sheet is used to
pull back relevant indexing information such as the patient’s name, birth date
and social security number. This makes the file searchable by multiple index
fields. Scharmann has found this information to be very useful when Medicare
audits the hospital’s ABN forms. "We are able to find the forms very quickly to
verify that they were signed," he said.

Billing Department--When an insurance company makes a
payment, it sends along an explanation of benefits (EOB). These documents
outline all of the details of what the insurance company will pay for. EOBs are
typically 50-250 pages. The documents are scanned into a cabinet in DocuWare.
Optical Character Recognition (OCR) is used to make the entire text of the EOB
forms searchable. Staff in the billing department must frequently refer to EOB
forms to answer questions when patients call in to settle their outstanding

"Before DocuWare, we had to put the patient on hold or call
them back when we found the information," Scharmann said. "Now we can pull up
the EOB within five seconds while the patient is on the phone and settle the

Scharmann estimates that this saves each of his employees at
least one hour per week. With five people in the department, that saves over 20
hours a month. Plus, the application freed up space with the elimination of four
filing cabinets in the department. However, Scharmann sees even more value in
the quality of service his department can deliver. "Even more than the cost
savings, the ability to get answers for the patient right then and there when
they are calling is the best benefit to us."

The Future: Medical Records--The hospital is planning
to move towards electronic medical records. This would involve a considerable
amount of time to convert paper files. Scharmann sees this as the future. In his
mind, there are two challenges to making the medical records electronic. "The
first is that this would be a change of culture for the entire clinic staff," he
said. "Secondly, doctors like to have a medical record in hand while seeing

He anticipates that during the early stages of an electronic
medical records model, they would be printing many of the medical records. With
some of the doctors using tablet PCs, this could be a platform to deliver
electronic medical records in a usable format. Overall, the hospital already
saves an estimated $20,000 a month with its new technology and an estimated
1,000 man-hours a month.

"Many departments are now interested in using DocuWare, but
it has taken time for them to become interested in scanning their documents,"
Plumb pointed out. "We have not been pushing the system. Rather, we have been
waiting for them to realize they need the tool."

Benefits to the Dealer

J&H Office Equipment has solidified its relationship with Bozeman Deaconess
Hospital. The dealership benefited by selling software, services and multiple
pieces of hardware. Plumb, however, feels that the benefit to J&H goes beyond
just the sale.

"Most of what we learned about healthcare we learned from the
hospital during the installation. We have gained valuable knowledge about
hospital terminology, workflows, processes and structure," he said. "This
knowledge will help us be more effective in serving other hospitals in the

Plumb advises other dealers to make sure the first hospital
they work with is near their office. They found that the first part of the
learning curve was time-intensive. "We spent many hours," he explained,
"training users, answering questions, overcoming transition problems and writing
special applications. But now that we have moved through the learning curve,
future implementations will be less challenging."

Parting Words

J&H Office Equipment did not, by any means, become a solutions provider
overnight. Plumb explained that the dealership took its first shot at selling
solutions in 1994. It wasn’t until three years later, however, that the company
achieved its first installation.

The dealership’s patience paid off. J&H has also installed a
system at Blue Cross and Blue Shield of Montana, which currently scans
12,000-17,000 claim forms per day, 200-500 correspondence documents per day,
legal documents, accounting documents, and a variety of other documents. Plumb
said it has been estimated that the organization scans 22,000-25,000 documents
each day.

"I spent three years," Plumb pointed out, "learning how to
demonstrate effectively, how to ask good questions, and how to design systems
that actually work."

Four Tips to Selling Solutions to Hospitals

1. Start with one departmental application and grow from there. It would be
overwhelming for a client to consider implementing document management across an
entire healthcare organization. Instead, begin by finding an application in a
specific department. Once the application is installed, it will naturally grow
through the organization. This will mean additional software, services and
hardware sales.

2. Don’t oversell the importance of HIPAA. As sales reps, we
are conditioned to lead with HIPPA compliance. While Title II of HIPAA does
mandate that patient information be kept confidential, every healthcare
organization has already taken steps to comply with this regulation. So, leading
with HIPAA compliance is generally not the hot benefit you may think it is.
Instead, lead by solving a departmental workflow problem. As an extra benefit,
point out how your system enhances the HIPAA compliance processes that are
already in place.

3. Focus on a hospital’s core business—patient care. In the
highly competitive healthcare industry, hospitals are open to ideas that help
them deliver better patient care.

4. Focus on a hospital’s key problem– collections. The
classic dilemma is that patients do not want to pay their portion until they
find out what the insurance company has paid. Insurance companies can tend to
drag out the payment of benefits. Show the hospital how having EOB forms can
help them improve the collections process.

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