GBMC Case Study

by Gordon Hoke

The Client

Created by a 1965 merger, GBMC HealthCare, Inc. is a leading Maryland health system that includes Greater Baltimore Medical Center, a 372-bed, nonprofit community hospital. More than 200,000 patient visits per year produce 4 million pages of medical records, required by state law to be retained for 25 years.

Included in the patient visits each year are:

l25,000 surgeries

l5,000 births (1,500 of them through in-vitro fertilization)

l40,000 emergency room visits (109
per day)

GBMC provides a continuum of care from prenatal through geriatric, from first visit through home health service. It includes medical offices for more than 100 physicians.

More than 3,000 employees work in six buildings located on a 58-acre campus in North Baltimore.

Eight Million Pages to Go…

When Greater Baltimore Medical Center (GBMC) met SolCom in 1995, the medical center had two critical problems: a mountain of paper records and a urgent need for speedy access to those records.

GBMC’s 1000-square-foot file room contained 8 million pieces of paper with 4 million of those being handled each year. Because the center was expanding its services and needed space for medical practices, GBMC wanted to shrink on-site storage space for patient records. The center also wanted to improve access to patient records while protecting confidentiality. Patient charts were used for billing, documentation for insurance companies, abstracting clinical statistics, reference on future visits, etc. With these multiple uses, immediate access to a paper record was not always possible.

A Failing Electronic Document Management System

In 1992 GBMC had installed a medical records imaging system, but it had failed to solve GBMC’s paper problem. Even with five FTEs assigned to put records into this system, the backlog of records waiting to be scanned was growing. As a result, the "to-be-scanned" pile had become an additional place for a patient record to get lost. Electronic retrieval of records and viewing were cumbersome and difficult with this initial system. The medical professionals were not willing to use it and continued to rely on the paper version of the scanned charts.

By 1995, medical center management decided a change was essential. "We had a lot of questions," said Douglas Fuller, GBMC consultant. "We wondered how we could revise our current document imaging system because we had too much invested to start over. We already had 4 million documents on it."

Converting to SolCom’s MultiManager for Patient RecordsTM

Enter SolCom. "We had a high degree of confidence in SolCom’s expertise," said Fuller. "The track record of SolCom principals as people who had developed the [IBM] ImagePlus system was a strong reference point."

"SolCom asked us to sketch what we wanted our knowledge management system to do for us," he said. "We told them we wanted a system with simpler document capture and retrieval and one which could be easily viewed with other applications throughout the center. They developed a plan to do just that."

SolCom suggested converting from the existing document imaging system to SolCom’s MultiManager for Patient RecordsTM. For GBMC peace of mind, SolCom also suggested converting in isolated, reversible steps, so that at any point there was always a bridge backward. Best of all, SolCom’s MultiManager for Patient Records required no image conversion, making system implementation very straightforward.

Within a month of installation, the backlog of unscanned records was eliminated. The MultiManager for Patient Records user interface was readily accepted by the medical and administrative staff, thus paving the way to move the paper charts off site. Charts were scanned the same day they were received. The new system was now compatible with GBMC’s line-of-business applications and Information Services standards, enabling the document imaging system to expand throughout the facility and more documents to be imported electronically.

"Throughout the conversion process, SolCom performed in an exemplary manner," said Fuller. "They met all their committed deadlines—the only delay in the implementation plan was at the request of the hospital. We now have a document management system that works the way we had originally hoped."

Adding a Robust Patient Data Repository

As GBMC was implementing its SolCom knowledge management solution, a decision was made to outsource to SMS-RCO as the Hospital Information System provider. As a result, MultiManager for Patient Records became a critical success factor in moving to the SMS-provided solution.

MultiManager for Patient Records’ Patient Data Repository is now used to collect information from the off-site hospital information system and the existing on-site speciality and departmental systems. The Patient Data Repository has become the single information source for the facility’s medical, financial and administrative staffs.

Moving all the hospital’s sensitive information to a single source and providing facility-wide and remote access could be a cause for concern. However, since MultiManager for Patient Records includes extensive security features to assure that only those who should see a particular chart or financial report can, GBMC’s executive management team was comfortable that patient and facility information would be protected.

At GBMC, the electronic document management system now has 40 workstations installed in nine different departments: Clinics, Emergency Department, Medical Documentation, Patient Accounting, Physician Offices, Quality Assurance Nurses’ Offices, Subacute Nursing Unit, Tumor Registry, and Utilization Review. Current plans include installing workstations on additional nursing stations and in clinics.

Improved Quality Assurance

The Quality Assurance department is very happy to have the MultiManager for Patient Records knowledge management solution.

With a paper system GBMC Quality Assurance Administrator Stephanie Gellner, R.N., found that the charts were not always complete or available, and she had to spend valuable time calling different departments for current information. "Now, instead of calling, I can be sure that the latest piece is in the computer," she said. The chart is available immediately, even if other people are accessing the same chart at the same time.

She found MultiManager for Patient Records straightforward and easy to learn. "If you have worked with computers before, the software is simple," she said. "It’s an efficient and accurate way to work. It [MultiManager for Patient Records] has changed my work dramatically!"

Streamlined Medical Documentation Processes

The Medical Documentation Department has seen a marked improvement in work processes due to MultiManager for Patient Records. "In Medical Documentation it is great to be able to provide multiple people with access to the same chart at the same time," said GBMC Supervisor of Medical Documentation Holly Olsen. "With SolCom’s document management system, a physician on a unit, a consulting physician in the Patient Record Office, and a quality assurance person can all be using the record at once."

"Loose filing used to be a big issue, and tracking pieces of a record was a never-ending process," she added. "Now it doesn’t matter if it goes somewhere. A complete record always remains in optical storage."

The Medical Documentation Department is now easily able to supply the medical staff with patient information when they need it. Physicians and supporting staff members are given electronic in-baskets or "workbaskets." The requested patient information is placed in the requestor’s workbasket and the user then, with a few mouse clicks, can view and work with the information on the workstation monitor. In patient care areas where workstations are not available, printouts of the pages of patient records are provided. Always on pink paper to identify them as a temporary record, these printouts are shredded at the end of the day.

Upon discharge, GBMC now puts all patient records into the document imaging system either through scanning or electronic document import. The paper record is moved off site in less than a month.

A Physician’s Viewpoint

One of the biggest thrills for the GBMC Information Services staff is that MultiManager for Patient Records is accepted and used widely by the medical and professional staff. Dr. John Wogan, MD FACEP, is an Emergency Department physician at Greater Baltimore Medical Center. Wogan has been using the system since 1996. "The SolCom electronic system is incredibly valuable to me," he said. "I use it in three ways: for immediate patient care, for quality assurance, and for research."

For immediate patient care in the Emergency Department, the SolCom optical system provides much faster access to patient data. "Getting to an old EKG can be crucial if we are treating a patient with acute MI," said Wogan. "It is extremely frustrating for me to have a very sick patient and to wait for a medical record which contains some very valuable information. Minutes seem like hours in those emergencies. Being able to quickly find the record myself on the optical system is a major help."

The Emergency Department and other physicians also use MultiManager for Patient Records for quality assurance. For example, GBMC’s Emergency Department is in a consortium with other hospitals tracking clinical and critical care issues. Wogan commented, "We use the electronic record system to create workbaskets focusing on specific clinical issues, e.g., pain control or time to thrombolytic therapy. Using the workbaskets, I can quickly access and review the relevant charts and track our clinical performance. It’s a lot faster than asking the Medical Records Department to find the charts for us."

Wogan said that the most exciting application for him is the use of MultiManager for Patient Records for research. "Emergency Departments, unlike other physician groups, tend not to track patients after admission," he said. "They see a patient, make a clinical decision, and another physician actually provides the care. We did a survey in Maryland a year ago and found that Emergency Department tracking after admission was very informal or nonexistent. We think that this is a detriment to [ED] clinical skills."

Wogan is now tracking patients using the MultiManager for Patient Records system to see if there are clinically relevant discrepancies from the initial diagnoses to the ultimate diagnosis. To help other ED physicians, he hopes to publish his findings and his methods of tracking with a document imaging system.

Poised for Success

Douglas Fuller sees a bright future for the knowledge management solution. "We are poised for success with SolCom," he said. "Our focus now is to expand document imaging throughout the hospital and further automate patient record completion."

End users echo his enthusiasm."It has changed my life immensely," said Gellner. "Without leaving my desk, I can review charts in a timely fashion and know that all the pieces are there for me. It’s absolutely fabulous!"