University of Arkansas for Medical Sciences, Expediting enterprise information flow with electronic records storage

By Bonnie Hipp posted 09-08-2010 13:48


UAMS was growing so fast that trying to accommodate the expansion was creating a serious challenge to its operations. As old buildings were being torn down to make way for larger, more modernized facilities, individuals and sometimes whole departments ended up in cramped, temporary quarters with no place to store all their documents. As departments outgrew their facilities, satellite locations were commandeered to handle the expansion. Filing cabinets of paper and microfiche storage were multiplying at such a rate that in some cubicles there was barely room for an employee’s desk. Not only was space becoming an issue, but the lengthening delays and growing expense in filing and retrieving information from one location to another was becoming unacceptable.

For instance, human resources housed its records two miles off campus, which created a document retrieval delay of up to two days when employees wanted to review their files. Because the OB/GYN department had expanded into three separate facilities, it had to pay to have huge filing cabinets hauled back and forth between the labor-and-delivery facility and the main facility every night so that patient records would be available for after-hours births. Other departments with space constraints, such as finance, were paying tens of thousands of dollars a year to have paper records sent off site and converted to microfiche.

The initial goal of the project was to reduce paper files and create a more efficient system for managing and retrieving documents for its human resources, finance and support services department—the Division of Administration and Fiscal Affairs. Ultimately, the solution had to support medical records, lab results and other healthcare, educational and administrative processes. The implementation had to support COLD (the storage of data on optical disk) and imaging capabilities and facilitate information sharing across geographically dispersed locations. Since UAMS is both a teaching hospital and a medical institution, a new solution would need to store volumes of academic and patient-related records for many years. The solution also had to provide easy access to historical information for departments such as purchasing and accounts payable and satisfy state and federal regulations regarding scanned documents to be viewed as originals.

UAMS chose to implement an EMC Documentum ApplicationXtender solution to cost-effectively scan paper documents of all kinds and store them in an easy-to-search electronic repository. With the addition of ApplicationXtender Web Access, users both on campus and at affiliated hospitals, medical centers and health education centers could access and view documents they needed through their Web browser. To further facilitate productivity, ApplicationXtender is being integrated with UAMS’ SAP environment to allow users to access electronically-stored supporting documents directly from their SAP screens.

EMC Documentum ApplicationXtender provided UAMS with a cost-effective way to scan paper documents of all kinds and store them in an easily searchable electronic repository. The first department to use the technology was human resources, which hired a third party to scan records for all current employees into the system and used its full-time staff to index the results for accuracy. Human resources found that managing employee records electronically was so much easier and faster than paper-based filing, not to mention freeing up more than 18 filing cabinets of space, that the department scanned in records for all past employees as well.

As word spread of this success throughout UAMS, more than 300 departments within the institution decided to convert their paper records to the Documentum electronic file storage system. These critical paper documents included invoices, contracts, plant operations information, building plans, construction bids, patient records, intern and residency information, grades, reference letters, signed HIPAA privacy forms, employee personnel information, purchase orders, property service information, grants, receiving and packing slips, and much more. All of these documents are now scanned into the ApplicationXtender system where they can be viewed instantaneously by over 850 UAMS employees from their desktops.

With EMC Documentum ApplicationXtender Web Access, information sharing now extends beyond users at the UAMS main campus to include authorized users at affiliate hospitals, medical centers and area health education centers. The Web access tool enables users to view images from the repository through their Web browser. In the case of one employee confined to bed rest for three months, ApplicationXtender Web Access enabled her to continue working from home.

UAMS is integrating the ApplicationXtender system with its SAP environment to allow users to view documents stored in ApplicationXtender from within their SAP applications. Currently, the purchasing, accounts payable and travel departments download SAP transaction information nightly. These transaction reports become cover sheets that are scanned on top of supporting documents—emails, bid proposals, receipts, hard copy invoices, trip expense reports, purchase orders, etc.—so that all documents related to an AP invoice number, purchase order number or trip number are linked together within ApplicationXtender. Once the integration is completed, users will be able to click on a transaction on their SAP screen to automatically launch ApplicationXtender Web Access and display all supporting documents for that transaction.

To address issues of disaster recovery, UAMS uses EMC Documentum DiskXtender each night to back up over one terabyte of information to two Xiotech storage area networks (SANs)—the second SAN being a mirror of the first—and an HP Surestore optical tape. The SANs provide easy access to historical information and the optical tape provides immutability and reliable disaster recovery.

 The transition from paper and microfiche to electronic document storage has saved enormous staff hours in filing and retrieval. It has even eliminated the need for several staff people and freed up hours of other employees’ time for more value-added activities.

In addition, UAMS has slashed the cost of offsite storage, as well as the delivery costs and time delays associated with shipping and carting documents back and forth across different locations such as the multiple sites that house OB/GYN records. Scanning current and past employee records into ApplicationXtender enabled human resources to eliminate paper document storage entirely, freeing up 18 file cabinets and numerous storage boxes, as well as eliminating the cost of microfiche for 100,000 documents annually. In 1997, when only three administration divisions were using ApplicationXtender, UAMS estimated that the solution was saving the organization approximately $30,000 per year. Today, with its use now widespread throughout the campus, the savings have grown appreciably, allowing the institution to allocate those funds for other projects and supplies.

Converting to electronic records management has also eliminated the fear of misplacing documents when departments move to new facilities, an activity that happens with some frequency as UAMS continues to expand. The OB/GYN department no longer has to haul files back and forth nightly; patient records can be viewed online at any time from any of the department’s three locations.

Having campus medical offices scan in their human resources information (time sheets, leave forms, verbal disciplinary, certificates, licenses, and so on) has helped tremendously with satisfying Joint Commission on Accreditation of Healthcare Organizations (JCAHO) audits. Campus audits are performed offsite using WebXtender so as not to inconvenience employees or disrupt their productivity during the business day. Images can be quickly copied to a single CD and sent to lawyers’ offices instead of printing and shipping reams of paper. Because physical space for documents is no longer an issue, electronic documents can be kept on the system longer for historical research and easier trend analysis.

Many departments have been able to go entirely paperless. They might start by storing 10 years of paper documents, but once they realize they’re paying for this storage but not accessing the records, they gradually reduce and eventually eliminate paper storage because they can find documents—whether for internal use or audit requests—much faster and more easily in ApplicationXtender than they ever could from a paper filing cabinet or microfiche.

 With all the construction and expansion activity happening on the UAMS campus, ApplicationXtender has allowed departments to reduce or eliminate paper storage, alleviating the concern of losing critical documents in a move. Coordinating activity among multiple locations and lack of space for paper storage were the initial impetus for departments to adopt ApplicationXtender. Once the online repository became part of daily routine, however, users found the ease of accessibility to information invaluable in doing their jobs.

Jane Benton, finance manager in the accounts payable and employee travel group said, “In the past, all documents were filed manually after processing. Retrieval was challenging and records were expensive to store. Now we have a permanent, accessible document retrieval system. We’ve quit shuffling documents manually across campus. And we’ve decreased the copying and marrying of documents that went to our Treasurer’s Office to send out with checks. The Treasurer’s Office can retrieve and print out required documentation as needed. This has saved the department $500 a month in storage rental costs and freed up 15 percent of our floor space which we now use for work cubicles.”

Betty Foster, director for procurement services, added, “This application has made our jobs so much easier. Simply having the ability to bring up every document associated with a purchase request/order enables us to assist users and vendors expeditiously and accurately.”

Jerry Higginbotham, business officer for the OB/GYN department, commented, “Before ApplicationXtender, we had to call the purchasing and accounting departments for information about receipts and payments. Now we can look that information up ourselves. We save ourselves an inordinate amount of time and no longer interrupt purchasing and accounting employees from their work. The old process took approximately 15 minutes for every request but now with it at our fingertips departments’ questions and issues are resolved in a timely manner.”

Mary McClain, the director of admissions for the College of Nursing, said, “Before we began using this program, we relied on microfiche to archive our records. We’d have to go to two separate locked rooms to retrieve a transcript and print out a copy—a process that took 15 minutes for each search. Now we scan the information and access it from every computer in our office without leaving our desks. We can quickly call up student information, even inactive records, without rifling through filing cabinets or searching microfilm sleeves. It’s a real time-saving asset because we can instantly share information among departments without having to copy and mail files. It’s greatly shortened the time between receiving and processing application information in one college and accessing the information in another. It adds up to several extra days of productivity every year.”

With ApplicationXtender, more than 300 UAMS departments have not only eliminated vast drawers of paper storage, but have saved countless staff hours in filing, retrieving and sharing valuable information across the campus and greater healthcare community. Productivity has risen while the cost of creating, storing and delivering microfiche records has been virtually eliminated.

In addition to the various UAMS departments, university auditors have also realized some concrete benefits in adopting electronic document storage. Digital fixed images stored in a secure, robust system are making their jobs a lot easier because electronic files are easier to track and retrieve and are less likely to be lost or misplaced than paper records.

What are the exceptional aspects of your project?
While many organizations have deployed the power of EMC Documentum ApplicationXtender to streamline document management, few have done so to the magnitude of UAMS. Today, Documentum supports 448 applications across the UAMS campus—everything from accounts payable/receivables to patient medical files, clinicaltrial reports, admissions applications, equipment repair manuals and construction management blueprints. Web access tools have enabled users at affiliate hospitals, medical centers and area health education centers to retrieve documents from the more than one terabyte Documentum repository and share information with as much facility as on-campus users. UAMS continues to scan approximately 144,000 pages into the system monthly and has virtually replaced paper archiving and microfiche campus-wide.

Human resources alone has eliminated the cost of microfiching 100,000 documents a year, including mainframe-generated reports. The department has eliminated 18 paper file cabinets, freeing up valuable office space for employee use. Accounts payable and employee travel has saved $500 a month in storage rental costs and freed up 15 percent of its floor space formerly occupied by filing cabinets.

Other savings include eliminating the expense of delivery services to transport documents among buildings and the cost of hiring temporary clerical staff to handle filing and back logs. In addition, employees spend less time on clerical activity—filing, sorting, copying, faxing and tracking down missing documents—and more time on value-added projects.

 Initially, there were concerns about the accuracy of the scanning process since the responsibility was given to a temporary employee. Various departments were reluctant to destroy the original paper documents for fear that valuable information might have gone astray in the scanning process and the original document would be needed to recapture it. As the temporary employee became more proficient in the scanning process, departments became more confident that the process was accurate.

Another other issue was the need to bar code documents scanned into a patient’s medical record to avoid data entry errors. Medical record numbers are fairly long, so the concern about transposing numbers when designating a document’s association with a particular patient’s file was justifiable. UAMS solved that issue by creating a unique bar code for each medical record that could be used when scanning documents. The bar code would serve as an index, linking all associated documents to the right patient file with no hand keying of the medical record number.

 There was some concern about job security when paper records were replaced by electronic files, but once employees saw the benefits being reaped by the pilot program in human resources, they were eager to realize the advantages of faster data retrieval and relinquish the inefficiencies of paper file cabinets. Auditors who were initially reluctant to rely on digitized documents were won over by the speed with which information could be accessed without having to interrupt busy department employees to pull paper records.

  Because of its broad adoption institution-wide, UAMS has served as a model for many outside organizations on how to expand their own use of electronic data storage technology. Officials from the Department of Finance and Administration for the State of Arkansas and the city of Fayetteville as well as other institutions of higher learning have come to UAMS to observe a live Documentum environment and learn how to use the solution to make their own departments run more efficiently and cost-effectively.

Ken Williams, Assistant Administrator for the State of Arkansas Department of Finance and Administration, Office of Information Services, attended a UAMS presentation on its imaging system and learned the pros and cons of centralized scanning, how campus offices work together to share documents, and how to set up and administer security.

“We saw the many ways their system changed their procedures and processes to save time, effort and space,” said Williams. “We plan to apply these lessons learned from UAMS to our newest imaging expansion project.”

Felicia Held, Division of Information Technology project manager at Creighton University, said, “We talked to other universities and you [UAMS] had the model we would most like to emulate. We are still in the pilot phase, but the feedback so far has been really great.”

Held reported that ApplicationXtender is enabling Creighton’s Medical Student Affairs Office to import electronic student files and eliminate paper altogether. Once the university goes into live production and is able to put historical information into the system, Held predicted the system will save staff significant time in gathering information and an exceptional amount of file cabinet space.

Once the pilot program was launched in human resources, other departments across UAMS jumped on the bandwagon very quickly. Part of the rapid adoption was driven by rampant physical expansion at UAMS and space issues: with so many filing cabinets stuffed to overflowing, there simply wasn’t room to grow. Departments forced into temporary quarters during construction of new facilities were facing the risk of losing valuable documents while in transition. In addition, those groups whose operations sprawled across multiple buildings were finding it hard to do their jobs because the records they needed were invariably stored elsewhere and difficult to access quickly. Documentum satisfied an immediate need to free up space, provided easy and instantaneous access to information from a desktop, and alleviated time-consuming and costly file and retrieval procedures that interrupted productivity.