December 1999
Sharing Access ... Protecting Privacy
By Debra Haverson
Opportunities and demands sometimes conflict. The regional health
care organizations that are gobbling up local hospitals, nursing homes and doctors’ practices
can gain huge efficiencies by centralizing accounting processes, human resources functions and,
increasingly, patient records. Meanwhile, the folks in IT have to find a way to share all that
information across dispersed locations while ensuring that it doesn’t get into the wrong hands.
Electronic document management has helped many health care organizations cut costs and improve
customer service in the bargain. As good as this sounds, these technologies may even help to save
lives as patient records enter the mix. A paper record of an individual’s chart or files can
only be in one place at a time, unless someone makes and sends copies by mail or fax. This, of
course, takes time and leads to duplicate storage, the creation of incomplete and/or outdated
records, and reduced control over access to confidential records, an area soon to become highly
regulated by the U.S. Health and Human Services (HHS) and the Healthcare Finance Administration
(HCFA). In late October, the Clinton Administration moved to introduce wide-reaching controls
over the storage and transmission of paper and electronic medical records, as well as over the
processes for access to these records. During the next few years, health care systems and services
such as Covenant Health and UICI Administrators (see sidebar) will turn to document technologies
to tackle the conflicting challenge of easing information access to authorized staff while
protecting patients’ privacy.
Covenant Health Links A Vast Network
Covenant Health is a large health care system in Tennessee that has committed to linking its five
main campuses in order to share access to accounting and human resources information and, very soon,
medical records. In addition to its seven acute-care hospitals, Covenant has outpatient surgical and
diagnostic centers, a mental health care center, a diabetes center, a nursing home, a fitness center,
a day care center, rehab therapy centers, senior care centers, home health care services, a credit
union, a home care division and a school of nursing.
This extensive network was formed in 1997 with the merger of two separate health systems. Soon
thereafter, Covenant Health began working with American Management Systems
(www.amsinc.com/healthcare) to implement
a document management system for its accounting functions. This initial solution, now known as
RecordLink for PFS (Patient Financial Services), allowed Covenant Health to centralize the
administrative accounting for all of its facilities at one location. This not only freed up physical
space in a number of facilities, it improved accounting efficiency and streamlined processing.
AMS’s healthcare-specific RecordLink suite is built upon integrated document management software
from FileNet (www.filenet.com). The various
RecordLink applications mentioned here sit on top of one unified, enterprise-wide FileNet layer of
software.
Documents are now either generated electronically within the organization or scanned into the system
early on. From there, documents and images are available almost instantly across a wide area network
reaching nearly every facility.
According to Linda Odorisio, a senior principal in AMS’s Healthcare Systems Group,
“Covenant had begun to see a delta between what they could do in their mainframe financial
applications — where they were collecting patient charges and generating bills — and the
actual activity and business of the patient financial services operation.”
The mainframe continues to handle the transaction and payment processes, but Covenant wanted workflow
functionality that could prompt workers to manage work more proactively. With 50,000 to 60,000
patient visits per year, this task required a more orderly approach.
RecordLink for PFS receives UB92s and HCFA 1500 physician billing information from the mainframe
and creates and/or inserts this information into electronic file folders for each patient. Everything
occurs automatically without human intervention. For example, a rule can be set up as follows: If
payer X generally pays within 40 days, but the mainframe has not sent a notice of payment to the
RecordLink by day 42, then notify someone in the department to follow up.
“This type of activity can increase a health system’s cash flow and improve its
relationship with payers,” says Ordorisio.
In 1998, Covenant moved on from accounting to bring its 9,000 employee and human resources files into
a more integrated management environment. Each file contained hundreds of pages of information.
Software from Cyborg Systems (www.cyborg.com)
provides a full suite of HR-specific functionality such as applicant tracking, payroll, benefits
and compliance with the Equal Opportunity Act, though it still necessitates use of paper. An
interface to the RecordLink allows Covenant to store and manage the large electronic files in optical
storage while employing workflow capabilities to create queues of tasks that require prompt attention
from HR staff.
Covenant’s latest improvement initiative involves electronic storage of patient medical
records. In September, the organization began a six-month implementation of RecordLink for HIM
(Health Information Management).
“We took a team of physicians to visit other AMS user sites, and they were very excited about
the prospect of having the technology available to them,” says Frank Clark, senior vice
president and CIO at Covenant. “The emergency-room physicians and internists, who are the
primary care physicians, were particularly interested.”
These doctors will gain instant access to patient records from anywhere within the system. Today,
each of Covenant’s five main campuses has a LAN that connects people in multiple buildings.
A secure WAN links all of the LANs and provides access to the centralized IT center, which houses
the mainframe, 80 IBM RS/6000s, 150 Pentium-based servers and a Hewlett Packard optical jukebox.
Once the system increases bandwidth through installation of fiber-optic cable, this will even make
diagnostic images like X-rays more accessible.
Clark says Covenant first determined how to improve record management before automating the process.
This clarified workflow rules and helped satisfy government regulations. The existing infrastructure
will allow for confidential, encrypted transmissions within the network; however, the IT department
is currently working to secure and certify the system’s ability to provide doctors with remote
access from home and/or laptops.
Not surprisingly, Covenant is investing approximately $18 million a year for five years in hardware,
software licensing fees and telecommunications infrastructure. It has spent $2.1 million on AMS
software, with another $600,000 budgeted for 2000. Clark says they have not developed
return-on-investment statistics, but he’s clear that the projects have improved operations and
the system’s ability to serve customers and staff.
“We try to measure any expenditure of IT dollars in terms of: Does it improve quality? Does it
contain or redirect costs? Does it improve accessibility to our services and is it convenient to our
customers?” he says. Thus far, he says, they’ve met all these criteria.
Linking Applications to Adjudication
Like many in the healthcare insurance industry, UICI Administrators of Irving, TX, has been scanning
and storing documents electronically for years. This third-party administrator handles insurance and
self-insurance health plans for a variety of corporate and government entities.
Working with sister company Insurdata Inc.
(www.insurdata.com) and its Insurdata Imaging
Services (IIS) division, also of Irving, UICI offers application and workflow solutions including:
- Insur-Claims, a paperless claims processing solution that allows for automatic adjudication (with
payment and/or statements) of claims.
- Insur-Admin, an eligibility system for various types of group and individual policies.
- Insur-Dental, a dental claims system that include auto adjudication and dental X-ray imaging.
- Insur-PPO, a re-pricing system for managing preferred provider plans.
- Insur-Enroll, a flexible employee self-service open enrollment and ongoing benefits information
management system that combines both Internet and interactive voice response (IVR) solutions.
- Insur-Web, an Internet engine that extends the functionality of other Insurdata products or
client legacy system by providing a secure, scalable Internet interface.
- Insur-Image, an imaging/OCR work tracking solution that can be integrated with the claims
processing function.
- Insur-Voice, an IVR system used to establish eligibility, determine claim status and for open
enrollment.
Each month, the in-house scanning operation at UICI captures 50,000 claims — generally HCFA 1550
forms or hospital UBs. It also receives claims from larger providers via EDI (see accompanying
diagram). Payers generally receive only 30 percent of their claims electronically, according to
Robert Weir, vice president of marketing at Insurdata.
In one recent month, for example, 36,484 out of 50,000 claims scanned at UICI could be read
completely by OCR. Approximately 20 percent of those read contained a code that automatically
routed them for specific processing. The remainder of those successfully read (approximately 28,000)
were sent electronically to IIS, which handles image processing and data entry among other service
offerings.
All claims go through the auto adjudication system at some point so UICI can send out an explanation
of benefits and, usually, a check. The remaining 14,000 claims (50,000 minus the 36,484 successfully
OCRed) contained attachments or nonstandard formats; these went to IIS for manual entry into the
document management process.
Whether input in-house or returned from IIS, work flows automatically at UICI, entering nine
different work queues that employees access sequentially to handle claims requiring human attention.
UICI’s extensive capabilities recently helped it win a contract to administer the health plan
of the United Mine Workers. To handle the union’s 210,000 claims per month, UICI will add a
new facility with more than 100 staff members, and it will have IIS scan the claims upon receipt
rather than doing this in-house.
Among UICI’s 27 major client groups, 15 have started using the Insur-Web application, which
provides social-security-number and PIN-secured access to information across the Internet and
delivery via email. The company expects the Web-based offering to reduce toll-free phone costs for
customer service assistance. Large health care systems will continue to use their established EDI
infrastructure to submit claims, predicts UICI president Diana Valdez, but she says smaller medical
offices will take advantage of affordable Internet connections to file their claims.
IIS’s Web product differs from other systems in two significant ways, says Emry Sisson, a
director for Insurdata. “We have made great strides in implementing XML,” says Sisson,
adding that it is used to embed contextual data into the image so it is fully described.
“[We’ve also used] image compression technologies such as jbig, which provides a more
compressed image than a TIFF image and reduces download time over the Internet.”
The software captures data, feeds the adjudication system and later re-associates adjudication
information with the image so users always have the most up-to-date information. Secure Web
capabilities will enable companies to provide remote access to individuals who prefer to
telecommute.
—Debra Haverson
|
|
