The economics of electronic efficiency: a three-hospital healthcare system emerges from a disparate, paper-laden clinical report process to a swift, centralized electronic system.

The medical industry is welt-known for being stuck in the paper age. Many vertical markets, like the telecom and financial industries, have already learned how to overcome problems resulting from paper workflow; healthcare is starting to slowly learn those lessons.

St. Elizabeth Medical Center, a member of Catholic Healthcare Partners (CHP), has three full service hospitals in Covington, Edgewood and Williamstown, Ky. In early 2000, we decided it was time to automate our clinical report workflow. We spent the rest of the year analyzing our processes, determining where the troubles were and what added costs we incurred because of them.

PROBLEM

Our decentralized clinical report processing meant that reports had to be printed, sorted, and faxed or mailed from multiple hospital departments. It took 10 to 24 hours for paper reports to reach physicians' offices because our mainframe systems would accumulate data during the day and print reports at night. They were not distributed until the following day.

Reports were handled separately in the medical records, laboratory, transcription and radiology departments, which meant a physician's office would have to call each department to make separate requests.

We estimated that more than 20 percent of reports sent to physicians' offices could not be located when they were needed. Most offices were also backlogged with filing. It was common for a physician, in the exam room with a patient, to open the chart and not find the report. The physician would then have to tie up staff time to order another copy, tie up the phone line while it was faxed to the office and tie up the exam room, where the patient waited until the report was received.

After conducting a comprehensive analysis, we found that our paper process cost us 42 cents per report. That included the cost of printing, postage and the personnel needed to physically sort and stuff reports into envelopes. When multiplied by each report generated for each department, it added up to huge costs that we could easily eliminate

SOLUTION

Realizing that technology could help us fix these problems and save money, we collaborated with HealthBridge to provide us with a private, secure network from which we could access Axolotl's Clinical Data Management Solutions. By early 2001, we installed Axolotl's Elysium Clinical Messaging system. Clinical results from our laboratory (including subspecialty labs) and radiology systems as well as transcribed reports were delivered electronically to our physicians and staff.

Elysium was able to bring together all of our mainframe computer systems using HL7 data feeds, and electronically distribute and store the data. Physicians automatically receive all of their reports via an electronic in-box that they can access from home, the hospital or any other secure Internet connection, including a handheld device. Our physicians have the ability to annotate, sign, share, manage and store clinical results, and to collaborate online with other providers in their communities.

To ensure the project's success, we formed a core team of physicians and office managers to learn and test the system. The group met weekly to analyze and discuss workflow issues. We then scheduled and conducted two to three 30-minute, hands-on training sessions for each office.

RESULTS

We immediately reduced costs by moving from paper processes to electronic communication for clinical reports. Currently, 150,000 reports, or 77 percent of our total reports, are sent electronically each month. Of these, 90,000 paper results have been turned off and are only sent electronically, saving us an estimated $453,600 a year (42 cents per result times 90,000 results a month times 12 months). The other 60,000 results per month are sent electronically to build an electronic repository; they are also batch-printed and distributed to the offices. We are phasing out our paper distribution, and we estimate that these 60,000 printed results will only be sent electronically in the near future.

We consolidated the reports from all departments, including lab results, radiology exams and transcribed reports, for centralized distribution through one Web-based system. Using Elysium, reports are sent electronically or via fax. By centralizing report management and distribution, our hospital saves more than $545,000 a year. For those physicians who have existing EMRs, we use an HL7 data link to feed the information easily into their systems. Physician offices that still keep paper charts are able to sort and batchprint reports prior to a patient visit, resulting in only one chart pull.

We estimate a 40 percent reduction in the phone calls and faxes to the lab and medical records department because physician staff can easily find results online. In fact, St. Elizabeth's lab volume has increased 40 percent over this period without any increase in clerical staff to handle the inquiries. Wait times for stat and critical results went from 10 to 24 hours to zero, with abnormal labs flagged for immediate attention.

A large Northern Kentucky orthopedic group uses Clinical Messaging to route discharge summaries to their billing service, reducing the number of days required to bill from 10 days to two days.

Even the offices that still print their reports save money. A large primary care group determined it would save 5 cents per report to print reports from a printer instead of a fax machine. They have switched to electronic delivery and estimate they will save $1,500 per month on printing costs.

The medical records department also saves money on chart pulls, because staff now has immediate access to all reports in a consistent format from one online location. Should a nonelectronic physician of fice lose a result, the physician office can call one number to access the missing report online. The report can be printed and faxed, without having to pull the patient's chart. We have eliminated our physicians' mailboxes, so patient information is protected. There is less paper exposure, and since the system is Web-based, we know exactly who is accessing it and what reports they have seen.

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SOURCE

Steve Slutzky

Physician Liaison and Recruiter

St. Elizabeth Medical Center

Edgewood, Ky.

PRODUCT/COMPANY

Elysium Clinical Data

Management Solutions

Axolotl Corp.

www.axolotl.com