Optical disk storage offers speed, efficiency
Optical disk storage offers speed, efficiency
Costs can reach the millions for some systems
Technology for storing medical records electronically on optical disks is overtaking paper records at a gallop. And although paper and computer versions of patient records will coexist like two branches of an evolutionary tree for some time to come, there is little question as to which method of storing information will emerge as the winner.
Optical disks are typically part of an integrated computer system that gathers health data from multiple sources throughout the hospital, including transcription notes, lab results, and images such as X-rays, and stores the information as part of an electronic record. The disks are stored in "jukeboxes," which can hold hundreds of the hard plastic protective boxes. Jukeboxes are commonly stored in medical records departments but can be located anywhere since record retrieval is electronic. The integrated systems allow multiple users to access medical records within seconds.
Many health care organizations have been using the technology for several years already and report high levels of satisfaction. "It’s wonderful," says Patricia Edwards-Capella, system administrator, application administrator, and supervisor of medical records at Dameron Hospital Association in Stockton, CA. "It cuts down on the amount of staff; it’s fast, accurate, and dependable."
When using optical disks to store medical records, documents are typically scanned daily by staff who have been trained in how to use the technology. Training time varies according to the complexity of the system and the familiarity of the staff with existing policies and procedures and can take from a few hours to several days. Many systems use bar codes on documents which identify patient name, account number, and encounter time. This information is cross- referenced with the Master Patient Index.
When Dameron began using optical disks several years ago, it transferred 10 years worth of information. That meant going back through the records and putting bar code stickers on every document, Edwards-Capella explains. Following a redesign of forms, all documents are now embedded with bar codes. That information is used to file the documents in a predetermined order. "It’s as if it was paper and in the same order," she says. "It’s set up with tabs to mimic tabs in a folder. Everything you would hold in your hand appears that way on the screen."
An alternative to bar codes is manually typing in the identifying information as each document is scanned, though this is obviously a slower process.
Optical disks offer more flexibility
The use of optical disks, on which a laser etches the information, is overtaking reliance on CD/ROMs for storage for a number of reasons:
• Better protection. Optical discs are encased in a commercial grade plastic container, which averts the risks of thumb print smudges, scratches, or coffee spills making data unreadable.
• WORM (write once, read many) technology. "It’s made for incremental writing. You can [scan] some pages over to the disk, stop [scanning], and then [scan] again," says Kelly McLendon, RRA, director of consulting and technical sales for Cincinnati-based MedPlus, which sells ChartMaxx information storage and retrieval systems.
• More suited to integrated systems. Because of the ability to add information incrementally, optical disks are more easily integrated into systems that continually feed information such as lab reports or physician or nursing notes to patient records.
• Greater storage capacity. While a CD/ROM can store roughly 650 megabytes of data, an optical disk can store roughly 2.5 gigabytes (a difference of a factor of 10), or about 50,000 records.
Optical image and document scanning involves a significant commitment of time, money, and resources. In an era of cost cutting, downsizing, and making do with less, this may not be feasible in the short term for many health care systems. Still, it’s important to be prepared for the eventuality of eliminating paper records.
One critical component of preparation for converting to optical image scanning is your budget. The technology can cost between $150,000 and $3 million depending on system capabilities. The most basic versions scan documents only. More sophisticated systems scan images such as X-rays, CAT scans, and MRIs. Such pictures, which contain shading from black through gray to white, take up more room on the optical disk.
Once the investment has been made, "There are tremendous efficiencies to be gained," says McLendon. "It reduces clerical staff requirements, allows you to do more with existing staff, and permits simultaneous access from several locations."
Dameron, which uses ChartMaxx, eliminated three full-time staff positions, Edwards-Capella says. And it offers other benefits. "Doctors like it because they can come in [to the hospital] and log on, and they don’t need a clerk. At least two doctors can see a chart at the same time. They can do it from their office, the doctor’s lounge; they have 24-hour access." Dameron has about one million documents stored on optical disk, she estimates.
An average ChartMaxx system costs about $500,000 McLendon says.
At Dameron, PCs are set up throughout the hospital, on each floor at the end of each nurses’ station, in the emergency department, and in the doctors’ lounge. "Lab reports are electronically transferred as soon as they’re ready," Edwards-Capella says. "It’s faster than waiting for the lab to print results, then getting it into the chart. That could take a whole day. Mostly it cuts down on sticky relations between doctors and clerks. This way doctors can find their records when they want them; it’s a lot faster."
Because of the considerable investment, it is important to decide how and which records will be archived. "Everybody always wants to scan everything," says Jimmy Prince, healthcare marketing manager for Lanier Healthcare in Atlanta, which sells DOCument Imaging/ES. But cost constraints usually pare that down, he adds.
There are several ways commonly used to phase out paper records in favor of optical disks, says Robert Wittenstein, product manager for Image Engine, developed by IMNET Systems Inc., in Alpharetta, GA. Image Engine systems range in price from $500,000 to $1 million and up to $3 million when image scanning is included.
Some of the choices are as follows:
• Start today. Wuesthoff Health Systems Inc., in Rockledge, FL, began the conversion to optical disks Oct. 1, 1996. They chose not to scan documents filed prior to that date because of the time and expense involved, says Debbie Madison, assistant vice president for medical information services. The hospital started with emergency department (ED) records. The ED was chosen because of chart accessibility and because it involved a smaller group of physicians, Madison says. "We thought that would be easier and [ED physicians] could be our resources for the other physicians to get them on the bandwagon." They then added outpatient and ambulatory surgery records, and plan to begin scanning inpatient records onto optical disks in October.
• Choose a date from the past and scan all records from that date. There is no rule for deciding how far back to go. For example, the Mayo Clinic in Jacksonville, FL, started scanning records four years back, Wittenstein says, because hospital policy dictates that if a patient hadn’t visited the clinic since that time the record is inactive.
• Choose a date from the past but scan the records of only certain types of patients. Cancer and maternity ward patients are an example of this selective scanning. "There are some patients who you know are active because they have a condition that requires continued visits to the hospital," Wittenstein says.
• Choose a date from the past but scan only certain types of records. In selectively scanning records, choose only the types of records that doctors are most likely to want to see, such as cardiac files, Wittenstein advises. Nurses’ notes, for example, can be left on paper. "Nobody cares what your temperature was eight years ago," he explains.
If you’re considering optical disk storage, now is a good time to review policies and procedures in your organization. "Look at processes and analyze how you’re doing things. Really look at your manual processes. Question everything that you’re doing. Ask, Why is that on the chart? Why do we do it this way?’" Madison advises.
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