Captovation: Rush University Medical Center Case Study

Captovation Capture Overview

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Rush University Medical Center Implements Distributed Capture System to Streamline
Current Document Capture Process

Rush University Medical Center (www.rush.edu) in Chicago, IL is an academic medical center that encompasses the 824-bed Rush Hospital, which includes Rush Children's Hospital, the 110-bed Johnston R. Bowman Health Center and Rush University. Rush University is home to one of the first medical colleges in the Midwest and one of the nation's top-ranked nursing colleges, as well as graduate programs in allied health and basic sciences.

The Rush Institutes bring together patient care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging. Rush is frequently ranked among the best hospitals in the nation by U.S. News & World Report and was recently named one of the nation's top hospitals by the Modern Maturity, a publication of the American Association of Retired People. And in June 2002, Rush became just the 51st medical center in the country to earn the prestigious Magnet Award for excellence in nursing services, the highest honor awarded by the American Nurses Association.

As health care has changed through the years, so has the amount of paper generated that is necessary to facilitate patient care. Rush’s Healthcare Revenue Systems (HRS) realized this as they faced an ever-increasing paper volume. This division of Rush oversees the patient billing and registration processes and handles such documents as explanation of benefits (EOBs), HIPAA notifications, and copies of patient insurance cards, photo IDs, etc. Processing all these documents manually took too much time, as did locating the documents once they were placed into metal file cabinets. “As our campus expanded and we served more and more patients each year, we also saw an increase in paper volume,” said Scott Halper, Senior Network Manager/Revenue Systems at Rush. “Processing all this paper by the most efficient means possible became a major priority for the HRS department.”

Furthermore, Rush also needed a more efficient way to backup their patient records for audit purposes. In those situations, manually finding all the records for a patient was becoming increasingly more difficult. Rush decided that an electronic document management system would help them with this problem.

Working with Imaging Office Systems (www.imagingoffice.com) of Fort Wayne, Indiana, a document management system integrator and reseller with an office in the greater Chicago area, Rush purchased Legato’s ApplicationXtender (AX) in 2002. Rush found that ApplicationXtender was easy to customize, which allowed them to add additional program functionality when the need arose. Additionally, Rush liked the fact that AX was web-enabled.

After deciding on Legato’s AX system, Rush’s next step was to find a new document capture system. Specifically, Rush wanted a system that would help them reduce the amount of time it took for records to show up within their document management system. With their old system, documents received at patient registration stations had to be couriered to the HRS building, where the documents would be scanned, manually indexed and committed (archived) into AX. The process of collecting the records and delivering them to the HRS building took a substantial amount of time, which meant that other hospital employees would not have immediate access to the records. Moreover, the process of manually keying index data for the document images further impeded their immediate accessibility.

“This was the bottleneck, if you will, for us,” said Halper. “Not only did the documents have to be couriered from the registration stations, but also unpacked, separated, scanned, indexed, and archived. Because the entire process took so long, we were becoming back logged with patient documents.”

Rush really wanted to automate the courier process via electronic means, and ultimately eliminate the need for courier services altogether. Essentially, Rush wanted to be able to capture the patient records at their source, the registration stations, and then send those images electronically to their AX system located in the HRS building. After conducting the needs analysis, Imaging Office Systems (IOS) recommended that Rush purchase Captovation’s eCapture distributed document capture module called ecNet. ecNet would give rush the ability to scan documents through a web browser and then send those images over Rush’s CAN (campus area network) to the HRS building with the click of a button. “We thought ecNet would be perfect for Rush’s needs,” said Scot Laudicina, Account Executive at IOS. “The program already had a tight integration with AX and also included the necessary features to allow Rush to automate their current document transfer process to HRS.”

Rush liked the features of ecNet, so they decided to purchase 26 ecNet licenses. The ecNet Clients or scanning stations are located at various locations around the campus, including the main registration area, emergency room, as well as the professional buildings (cancer center, heart institute, et al). Essentially, Rush decided to implement ecNet at any location that required registration staff.

In addition to ecNet, Rush also purchased eCapture’s bar code recognition server, ecAutoFile Server, which would give Rush the ability to automatically index documents that had bar codes on them. For example, HIPAA forms contain bar codes with the patient’s medical record and visit code (surgery, etc.). After scanning the records with ecNet, any image containing a bar code is routed to ecAutoFile Server where the bar code data is extracted, patient information retrieved from the host mainframe, and the documents are archived into AX. “ecNet solved our biggest problem, the lag time involved with couriering the documents from the registration stations, but we also wanted to reduce the amount of manual data entry required once the images were received at the HRS office,” Halper stated.

Rush’s new capture process starts at the various patient registration stations on campus. A patient checks in, fills out the various forms (HIPAA notification, coordination of benefits, etc.), and hands over their insurance card and drivers license so that copies can be made. Hospital registration staff members then scan the various documents with ecNet using either a Canon DR 3020 or Visioneer Strobe XP 100. Registration staff also enters the patient’s data into Rush’s host admission system called PCIS – Patient Care Information System.

The images and associated index data are then sent from the various ecNet scan stations to the ecNet Server that resides in the HRS building. Once received, the ecNet Server routes the bar coded documents to ecAutoFile Server where the bar code data is extracted and populated within document index fields. Additionally, Captovation wrote a custom macro that connects ecAutoFile Server to Rush’s PCIS by utilizing Rumba terminal emulation software. Once a bar code is read by ecAutoFile Server, the macro connects to PCIS via Rumba and retrieves the additional patient information. This data is then automatically populated within document index fields. This host lookup eliminates the need to further index the document images and ensures that all relevant index data is associated with the image. With this application, Rush is currently processing between 3,500 and 4,000 documents per day.

The biggest benefit that the combined ecNet/AX system has given Rush is the fact that document images are now immediately accessible after a patient checks in at a registration station. Patient records no longer need to be couriered to one central location for scanning and indexing, which means no more courier concerns. Additionally, finding patient records no longer takes great amounts of time. There are some instances where a patient’s insurance provider would deny coverage until they see the patient’s records. Those records can now be quickly found by doing queries in AX.

Another benefit that Rush has realized with their new capture system is that ecNet can be easily deployed at any location on campus without any time-intensive software installation. ecNet client locations can be added by simply connecting to the ecNet server through a web browser, downloading the ecNet client – Active X component – and connecting a TWAIN-compliant input device. This has allowed Rush to implement new ecNet locations with minimal support requirements.

“In considering distributed capture software, we really liked that ecNet did not require software installation at the remote sites,” said Halper. “This has allowed us to get scanning stations at the registration points up and running very quickly. Additionally, the program is very intuitive, which meant that we did not have to go through an extensive training process with patient registration employees.”

Furthermore, the fact that ecNet utilizes the TWAIN interface has also helped Rush save money. Rush is now using 45 Visioneer Strobes, which retail in price for under $300. These low-volume scanners contain the necessary TWAIN drivers and are perfect for distributed scanning environments because they are USB (universal serial bus), which means they are essentially plug and play hardware. No SCSI cards need to be installed, a fact that further reduces support costs at Rush.

ecAutoFile Server has also given Rush the ability to almost completely eliminate the need for manual data entry. All documents that contain bar codes are processed by ecAutoFile Server, which means a large data entry staff is not required. This has helped the hospital reduce labor costs. Furthermore, the accuracy rates that bar code recognition offers has enabled Rush to index documents electronically without much worry for misreads, which would then call for re-keying the data manually. Host information lookups are performed based upon the extracted bar code value, further eliminating the need for manual data entry.

“ecNet combined with ecAutoFile Server provided us with an electronic system that would scan and automatically index our patient documents. The combined components require little to no manual intervention except for the initial capture process at the registration stations. This has greatly improved our document management procedures,” Halper concluded.

Rush is so happy with the implementation of ecNet at their various registration stations that they are considering expanding the system to other registration offices on campus. Furthermore, Rush is happy that the combined system meets today’s HIPAA compliancy requirements. All patient data captured at the ecNet Client locations is sent to the ecNet Server using secure socket layer, which encrypts the data. Only Rush employees that have license rights to AX can view the document images.

Rush also foresees using ecNet/AX for other hospital applications. One application being considered is a patient’s medical chart. These charts can be scanned by ecNet at the emergency room or any professional building and sent to the hospital’s AX system. Doctors involved in the treatment of the patient who may not be on campus that day can log into the AX system, review the patient’s chart, and then be able to immediately discuss treatment options. This will allow the patient’s treatment to progress more quickly.