Infonomics readers met Nancy Richards in the last issue, where she was profiled and interviewed as one of four business leaders who are maximizing the return on enterprise content management (ECM). As promised, we now give you a closer look at what Nancy is doing to help her employer reduce its carbon footprint.

Since going live with its green initiative in Spring 2008, Swedish Medical Center—which includes three hospital campuses, a freestanding emergency department, home health, and approximately 70 clinics in the greater Seattle area— has already digitized nearly three million pieces of paper, and it’s just getting warmed up.

Infonomics: Nancy, what was the genesis of this project?
Richards: Seattle is a very green city, and Washington is known as “The Evergreen State”. We’re all concerned about our carbon footprint. And here at Swedish Medical Center (Swedish), we’re looking at how much energy and waste we’re saving by not duplicating paper. That’s a huge consideration, and, happily, goes hand-in-hand with my mission. My title is ECM Systems Architect, and I was hired nearly three years ago to support the content portion of our Electronic Medical Records (EMR) system implementation, and then migrated to the “enterprise” IT division to help improve our business processes by leveraging ECM.

Infonomics: What sort of documents are we talking about?
Richards: Medical records comprise an extremely wide range of documents. It’s everything that relates to patient care, whether it be health insurance cards, health insurance documents, doctors’ notes, lab results, or signed consent forms and other HIPAA (Health Insurance Portability and Accountability Act) required documents. It might also be faxes from an outside provider to Swedish.

The objective is to integrate all hardcopy or non-system generated information required to complete the electronic medical record (EMR), and support best practices for patient safety. My role is to support best practices, regulatory compliances, and—working with both the vendor and the business side of Swedish—come up with a well-architected solution. I was very fortunate in that Swedish already had a small, underutilized installation of a content management system known then as Stellent—which was recently purchased by Oracle—as well as Kofax, which is one of the largest indexing and document-capture software options. Together with our integrator, ImageSource Inc., we were able to build an excellent system that supports our needs 24/7-365.

Infonomics: Where did you go from there?
Richards: After integration testing we focused on business process management, to design a seamless user interface that would have the smallest impact on our users, while providing the best results. Admins, nurses, physicians, sonographers, X-ray techs, and other practitioners at Swedish were accustomed to using paper cards, notes, films, and other hard-copy data that health information management staff had to collect, sort, and file several times throughout the day. Our objective was to begin with the paper as it entered the business workflow, and that generally is at the registration desk.

Infonomics: Can you tell us the exact hardware you use and boil down the business process?
Richards: Sure. We installed small-footprint scanners at incoming patient centers. We chose the Fujitsu 5120C model because they enable us to capture both sides of documents of almost any size, in color, of almost any thickness, and in a single pass. The business process is a win for all— patients, medical staff, and Swedish. We call it “forward facing.” Under our new system, you, the patient, hand your insurance card and other documents to the registration staff, who, remaining seated, scan them, while at the same time confirm any details as needed regarding your appointment and answering any questions. Thanks to this technology, data capture takes but a few seconds.

Now, this may sound like small potatoes, but, taken over the course of a single day, it’s a really huge win for customer service, staff time, and— of course—paper reduction. Think about it: registration staff now no longer have to do any of the following:

1. Stand up, take your health insurance card and other documents, and walk to the photocopier;
2. Fight paper jams;
3. Photocopy both sides of dual-sided documents, opening and closing the photocopier lid twice;
4. But, first, stand in line, waiting while someone else is trying to accomplish the same cumbersome tasks; and
5. Come back to the front desk with a jumble of papers, realize they’ve missed one document, and start over.

Today at Swedish, admins remain seated, facing and interacting with patients. It’s clearly a more humanizing process. They capture the documents, verify the quality of the scanned images, and upload them directly into the patient’s EMR—making them instantly available throughout the system—and return the originals.

Infonomics: Did you do all of this at once?
Richards: No. The first phase was to scan documentation, and now we’re in the middle of the phase II, which is to capture faxed information before it goes to paper. So now the fax machines are going away, which saves money, and, just as important, desktop real estate savings. I’ve seen some numbers on the annual cost of fax machine maintenance—it’s incredible. We are pleased to be able to have such immediate cost containment—again with a green benefit. But I can’t say enough about the cultural process, and the need to approach changes on an incremental basis. Adding just one more concept or function to overworked staff can make them feel like they’re drinking from a fire hose. My experience has been that a tremendous amount of hand holding and just being there in person can mitigate many cultural challenges. Once staff experienced the immediate benefits of “forward facing,” it was like, “Wow—this is great—give me more!” The user demand to complete phase II is so great that it is moving us toward stepped implementation by document types. And we’ve found no one who prefers paper faxes over electronic; everything from image quality to immediate access has been seen as a benefit.

Infonomics: Have the scanners held up?
Richards: They just keep on working and working. We’ve had virtually zero downtime with them, nor their predecessors, the 4120C, which we used for a different application for more than two years—that is very important when considering the total cost of ownership (TCO). Down-time is not acceptable. TCO is critical. My objective was to choose a standard scanner we could use throughout the organization that required low maintenance and was simple to use. We also wanted hot-swappable scanners available for all locations to help ensure uptime. That means that our desktop support team has scanners available for immediate replacement. We have not had to take advantage of them but the plan is in place and functions well.

Infonomics: Can you give us more of the nitty-gritty on ECM?
Richards: Certainly. Our first goal was to provide support for the EMR implementation. The ECM system design needed to be scalable and flexible as we grow our EMR program and roll out strategy. Standard capture software processes usually have a list of index values that live within the capture software; in our case that would be Kofax. Because we wanted the lowest support and maintenance overhead, we chose to have the index values passed from the EMR system—where they are maintained and modified as required— to the Kofax capture software dynamically. This allows the system maintenance to largely be within one system—the operating system of the user. This also reduces the amount of reconfiguration which might occur during a software upgrade of either the EMR system or the Kofax system. Again—we all like that. We’re using the Kofax ACIS (Ascent Capture Internet Server) module. From within the EMR, this information is passed dynamically into Kofax with no user response required within Kofax—only their standard processes in their EMR operating system. The image is captured and unique IDs are then passed back to the EMR and the Oracle repository. This then prevents any software upgrades from causing a domino effect. There is a small programming footprint that manages this process.

Infonomics: Where do you go from here?
Richards: We’ve digitized nearly three million pages of documentation since going live this past spring that formerly would have gone on paper, and that’s pretty green, and we we’re very proud of that. And that’s only within my domain—the “externally” generated documents—and that’s only phase I. Our goal is to be completely electronic across the entire enterprise in less than five years. We’re just entering into year three. In addition to our green approach to paper reduction, we’re also migrating many of our servers to “virtual” servers. This includes many of the ECM servers. As you might imagine, this saves significant electricity—and dollars—for Swedish. It’s a great privilege to be part of a team that sees the bigger picture and the interoperability of the ECM system processes.