Vol. 12 •Issue 23 • Page 16
Harness the Power of Indexing in the HIM Department
Thirty years ago, a medical records clerk might not be able to find a woman’s records if she didn’t know the husband’s name. In some hospitals, a woman’s name appeared as Mrs. John Doe (Thelma). The industry has come a long way since then, but one thing still holds true: if the indexing is incomplete, the record might as well be lost.
Today, health information management (HIM) departments are setting higher standards for search and retrieval of medical records. The top of the line, of course, is a full-blown imaging system. But the truth is, without the index, its images would be as inaccessible as the memories in the brain of an Alzheimer’s patient.
Most hospitals can’t afford full imaging yet. But, regardless of a hospital’s archival format, there is an out-of-the-box indexing solution that can provide quick and easy access to records.
Indexing Speeds Search
John D. Archbold Hospital, Thomasville, GA, has film going back to 1925. “It’s our policy to maintain these records for our community,” said Frances Turner, director of HIM for the Archbold Medical System. “It’s not uncommon for us to receive a request for records from 1935. They may be having a complication late in life or may want to know what a grandparent died from.”
This service is so important to medical staff and the community that Turner had all of the old film indexed a decade ago. Granted, they had to change vendors twice to achieve the accuracy they needed, but it was worth it, Turner said. “If a record isn’t indexed properly, it can take hours or days to locate.”
Today, a single master patient index (MPI) holds information for the main hospital and Archbold’s four affiliated facilities. HIM staff at any of the five can readily determine which campus has the records they need.
Indexing, a Strength of Imaging Systems
“It just makes sense to harness computer power for the most tedious jobs your full-time equivalents (FTEs) do,” said Dan Stober, national sales manager for EDCO– The Document People, Springfield, MO. “Hospitals are finding it worthwhile to move to indexing today even if the electronic patient record isn’t coming soon. Even if the records are kept on film, productivity increases dramatically when hospitals have a good computer index to automate their search.”
Medical Records Director Tami Long employed a related strategy at Elkhart (IN) General Hospital. When creating the index for the hospital’s new imaging system, Long had the vendor back-load two years of the MPI.
“By linking the MPI to the film index, we capture the best information the hospital has and use it to index the converted film records,” said Jane Henry, EDCO’s data services manager. “It’s the same basic process used to index imaging systems.”
In the real world, however, the MPI may be an imperfect tool, with hidden duplicates and wrong numbers. “By putting the information in a Microsoft Access® database, we can provide additional fields at the hospital’s request that the department can use to help clean up duplicates and errors,” Henry said.
CAR Improvement over Microfiche
In the early days, microfiche offered a welcome improvement over old-fashioned roll film. The indexing used a simple index to be sure, but at least you could file all patient records in one place. Theoretically. Problems developed, however, when HIM staff got behind on interfiling or when human error caused misfiles. Then, a search could take a really long time.
Computer assisted retrieval (CAR) was a quantum leap forward to a master database that houses all indexed records and points users to a specific film roll. Once the roll is inserted, the computer automatically directs the reader-printer to the correct blip on the roll. Unlike the tedious interfiling of fiche jackets, rolls can be quickly and easily returned to their proper storage place.
Granted, everyone knows an HIM director with a CAR horror story. Some vendors have messed up the indexing by missing rolls or records, and by using erroneous dates on rolls. For Kellie Greer, medical records supervisor at Memorial Hospital, Belleview, IL, the nightmare was poorly blipped film that the reader/printer could not search reliably. With their new vendor, however, the system works beautifully. “The index lets us easily find records that were filmed out of order, and it helps us locate duplicates, too.”
Clearly, for every problem there are scores of successes, and CAR indexing has come into its own. One way to ensure a good outcome is to scrupulously check references and verify vendor claims.
CAR Indexing Eases Pain of Multiple Systems
Over time, the microfiche at Wayne Memorial Hospital, Goldsboro, NC, had been indexed in a variety of ways. “A search could involve index cards or microfiche using both alpha and terminal digit filing systems,” said HIM Director Carol Fowler, RHIA.
Two years ago, the hospital purged three years of records and installed them in a CAR system. The 1,700 rolls of film filled just two-thirds of a single cabinet. Now, Fowler’s staff finds they can complete nearly 80 percent of retrievals using the CAR system or the single year of paper records on the shelves. Being able to type in an identifier in a single system has really speeded things up, in part by eliminating interfiling and misfiling.
“Now, we can get old EKGs for the Emergency Department in five to 10 minutes instead of 30 to 45 minutes,” said Fowler. The index resides on a single central retrieval station, which comfortably meets the department’s needs.
Several retrieval stations house the CAR index at Floyd Medical Center, Rome, GA. Floyd Medical is the only obstetrical hospital in Rome, and it serves a wide outlying area in Georgia and Alabama as well. “The physicians really want to see the records,” said Medical Records Manager Shelley Anderson, “Especially if the patient is in for a repeat of an earlier problem.” Fast retrieval from film has helped the facility improve patient care, she added.
At UofL Health Care, University Hospital, Louisville, KY, CAR indexing provided a giant step up from microfiche, said Medical Records Director Walter Zupances. They began CAR indexing in 1996, and it’s easy for staff to sit at the computer station and search by name, medical record number or visit date. What’s more, the indexed CAR roll film is actually cheaper than the old microfiche, he said.
At this 404-bed teaching hospital, Zupances refers to the CAR system as a “Poor Man’s Computerized Medical Record.” By combining CAR indexing with a digital reader/scanner, UofL HIM staff can digitize microfilm images on demand and load the images into the hospital’s network for distribution. “Microfilm archiving remains the least expensive archiving medium at the present time,” he said.
Barcoding Automates Indexing
When Elkhart General Hospital made its entry into imaging early in 2002, they began with the electronic storage system component. Aside from the $1.5 million price tag, Medical Records Director Long said the most painful part was redesigning and barcoding all their forms. Barcoding eliminates manual indexing and permits form-level searches.
As part of the move to imaging, Elkhart also established electronic signatures, contracted for physician training, set up electronic feeds from dictation, radiology transcription and lab, and started scanning the other 75 percent of the records that are still created on paper. The cost of the storage system itself pales next to the $16 million they’ll invest when they convert the clinical side to imaging.
Although costly, the system has brought Elkhart tremendous benefits. In their intensively indexed imaging system, searches now take one-fifth the time. Delinquency in chart completion has dropped from 45 percent to an astounding 6 percent, Long said, and the system creates detailed audit trails for Health Insurance Portability and Accountability Act (HIPAA) compliance.
Proper Indexing Is Forward-Compatible
Titus Regional Hospital, Mt. Pleasant, TX, is a best-case example of forward compatibility of properly indexed film. They moved up from microfiche to CAR for their 1997-1999 records. “We then converted their original DOS database into an Access product that brings the index into a Windows environment,” said EDCO’s Henry.
“Now, we’re accepting proposals for an enterprise-wide day-forward hospital information system solution that is to include day-forward document imaging capabilities,” said Titus Materials Manager Danny Parker. “The RFP requires that we be able to access the CAR database from the new imaging system.”
HIM Director Evelyn Simon was the driving force behind Titus’s upcoming archiving project. They will convert year 2000 records to SecureDisk™ digital images on CD-ROMs. These CDs will contain non-proprietary TIFF images that are easily accessed with Express Image™ software or an existing imaging system. The CAR database can simply be poured forward into the new database, resulting in a single search tool.
Simon has also been considering another logical step in this sequence. When budget allows, they may purchase equipment that will allow them to scan film on demand and import the images into their computer or network.
There is no doubt that good indexing is an indispensable organizational tool that would bring benefits to every HIM department. The keys to making the experience productive and not disastrous, regardless of format, is to ensure the vendor provides good data and image quality, attention to system compatibility and flawless indexing.
Margaret Castrey is a writer and consultant in Springfield, MO.
