The True Cost to Capture Nov 4th, 2009

Article from Advance for Health Information Executives Magazine
Vol. 13 • Issue 11 • Page 14
HIM Spotlight

Eliminating paper is a crucial goal, but in reality many of the steps taken may add unnecessary and often hidden costs. Equally frustrating, your health care organization may not achieve the full benefits of an imaging system.

In the effort to initiate an electronic document management system (EDMS), Health Information Management (HIM) departments often rely on scanning, a traditional capture process. However, scanning is just one component of a very complex and varied system.

With growing documentation and budgets constraints, in many cases HIM has to limit the amount of charts that can be converted, thus creating a hybrid document environment. This situation inadvertently consumes more direct and indirect resources and transfers burden to other departments. New capture technology provides the opportunity to alleviate some of these problems.

Calculating capture costs

Working together, Finance, IT and HIM can take the first step in reducing the expense of capture by discussing all of the components that drive the costs. The primary process can be divided into three buckets: pre-scan, scan and post scan.

Only about one-fourth of the costs are associated with the scanning task itself. Therefore, pre- and post-scanning activities are the best places to find cost efficiencies and improve performance.

Pre-scanning tasks involve physically gathering paper throughout the facility and all of the preparation of documents prior to loading the scanner. Prep requires activities such as counting pages, taping torn pages, unfolding pages, and removing staples and clips. If forms have not been redesigned with barcodes, FTEs must apply the codes or insert separator sheets.

Post-scanning requires indexing either at the event or document level. This can be accomplished manually or automatically depending on the system. The final step is quality review to ensure document clarity and total capture.

Many organizations overlook or underestimate costs in initial project planning. Additionally, some expense is disassociated with capture and instead is buried within overall department budgets. To begin calculating the cost per image (CPI), add total direct capture costs for a month, depreciation expenses, indirect salary expenses, space and utilities, indirect management and support time, and interest value of average days of revenue in capture, then divide by the total images captured during the month.

With the traditional capture process, CPI averages about 20 cents. Using new technology, that cost should drop to 10 cents.

In addition to impacting the HIM department, electronic documents affect the workflow of patient financial services and patient care. Organizations almost always fail to associate these aspects with the overall cost/value analysis of a capture process.

Overcoming pain points

In the search to help hospitals and clinics better cope with the hybrid medical record, EDCO Group Inc. uncovered a number of pain points. This led EDCO to offer specific recommendations, along with the development of new capture technology, called Solarity, which is designed to address many of the identified problems.

Facilities in the planning stage should be aware of emerging technology that can help them to prepare the best environment for starting a capture program. Those already in the program should be looking for ways to achieve continuous improvement.

The following areas often indicate underlying problems:

• Delayed revenue cycles. The goal should be to gather and process charts within 24 hours of discharge. This requires dedicated staff, strict chart-completion procedures and a monitoring system. Improved technology reduces much of the pre and post labor by automating and speeding up task completion.

• Excessive labor handling or form revision. Instead of barcodes and separator sheets, Solarity uses a unique form-recognition process. Loose sheets; photos; and various sizes, colors and weights of documents can be converted without exception scanning. Innovative processes reduce scanning errors that can occur with traditional scanning. Correction of errors adds 30 percent to the cost and time of scanning, but to miss an error can be devastating.

• Incomplete EDMS. Two factors are at work here. One is the inability to pull the chart together and scan within the desired timeframe. The second is a budget decision that leaves patient information as part paper and part electronic, perpetuating the hybrid environment.

Both of these situations increase the number of times a record has to be accessed before final processing or review by various functions including coding, analysis, record completion, patient care, release of information and RAC audits.

In addition to higher access costs, tracking down information significantly decreases workflow performance and can cause errors. EDMS software can help by being pre-set to monitor, alert and delay routing to specific functions until all relevant documents are available.

Enhancing electronic investments

Hospitals and clinics are spending tremendous amounts of time and money on electronic initiatives. A bottleneck in HIM due to insufficient technology and manpower leads to an unnecessary drain on resources throughout the organization.

To extract the most out of capture budgets and to improve workflow, HIM should acquire technology that reduces labor, speeds up document processing and minimizes the need for error correction.

Outsourcing on-site capture and backfile conversion to companies such as EDCO minimizes the hybrid environment. Paying a flat fee per image improves budget control and often reduces or redeploys overall costs to allow for more conversion per dollar.

Ms. Devadas, EDCO's director of document capture solutions, has more than 22 years of experience with EDMS systems, and was part of the IBM team that delivered the first document imaging solution for midrange systems. She recently joined EDCO as a result of the merger between EDCO and SolCom, Inc., an EDMS software and services provider.

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