Jukeboxes Heal Hospital's Paperwork Problem

By definition, hospitals exist to heal patients. In the process, however, they produce huge amounts of paperwork and sometimes the administration of this paperwork can get in the way of that mission. Florida Hospital treats hundreds of patients in a day at its 45 centers around Orlando, who together accumulate thousands of pounds of paperwork - all of which is processed in a single location. Until recently, faxing was the time-honored way to ensure that the 22 people, such as accounting, records, and other administrative personnel, who typically needed to review a patient's record, would have rapid and reliable access to the data. Faxing was also used to ensure that the hospital complied with the legal requirement that all original records be kept at the location at which the patient was admitted. Finally, staff would resend the faxes to patients' insurance companies for payment.

"We were spending a lot of time chasing down paperwork and processing the documents to ensure that all the appropriate parties received copies," said Fred Galusha, vice president and chief technology officer at Florida Hospital.

The Right Tools Save Money
The country's third-largest civilian hospital realized that a combination of document imaging and optical storage might be a better long-term prescription. Its high-speed network made enterprise-wide access to information possible, and many of the processes were excellent candidates for image-enabling. If he could acquire a powerful storage system, Galusha believed he would be able to create an efficient system for information sharing. All he needed were the right tools for implementation. "We needed a tool set that could be customized to integrate into our existing architecture and was scalable," said Galusha. He decided on four jukeboxes: a Panasonic LF5010, a DISC D510 and two Hewlett-Packard 100STs. For software, he selected two of Optical Technology Group's (OTG) software packages: ApplicationExtender, for image-enabling business applications, and DiskExtender, for managing mass storage. ApplicationExtender has been used to image-enable more than 2,000 distinct transactions, including patient management, urgent care, and emergency and financial applications.

How The New System Works
The moment new patients enter the hospital's care system their insurance cards are scanned into the system, routing the relevant information across the enterprise. If patients receive emergency treatment in one location and receive follow-up care in another location, their information is already in the system, eliminating the need for records to be copied and faxed between offices. Admission records are also scanned and distributed. A fax server automatically faxes a copy to the insurance company. Just by eliminating the old copy-and-fax relay, Florida Hospital saved more than $7 per admission which amounted to savings of more than $250,000 per year. Galusha believes that moving the applications off the mainframe, and creating a client/server environment to run the programs, will reduce the load on the mainframe by 25%, and save the hospital thousands of dollars in mainframe cycles and upgrade costs.

The hospital also liked the fact that the imaging and mass storage software runs on Windows NT. Data retrieval times are faster than on the mainframe, said Galusha, noting that he plans to migrate much of the network architecture to NT in the next few years. Galusha estimates that each patient record will ultimately require approximately one gigabyte of storage. To accommodate this demand, Florida Hospital is relying on a combination of magnetic disk, tape and optical disk. The DiskExtender software provides advanced virtual device management, data migration, caching, automated event scheduling, media compaction and NT-level security.

The Future Is Now at Celebration Health
Florida Hospital is also creating one of the most advanced new health facilities in the United States, in partnership with Disney Enterprises, Inc.'s new planned Community of Celebration, scheduled to open this year. The goal is to apply technology to treat the ‘total patient'- and lay the foundation for instantaneous updates of records and, consequently, more responsive patient care. The system will provide all patients with insurance cards, much like Florida Hospital does today. All new records will be created electronically, and all records - including x-ray images - will be stored electronically. Centralizing patient data will greatly reduce the need to handle large volumes of paper and will virtually eliminate the risk of losing critical patient information. Using the combination of the ApplicationExtender software and the planned network's extensive communications capabilities, doctors will be able to view and update records immediately, using handheld computers. Physicians and nurses will be able to electronically review lab results online, and automatically notify the pharmacy of new or revised prescriptions. The same paperless system also will let Celebration Health electronically manage almost all of the billing process with insurers.

Celebration Health will also be filmless: Medical images of x-rays, mammograms, ultrasounds, and MRIs will be stored exclusively on optical disk. It's estimated that each patient has about twenty-four x-rays taken over a lifetime and each image must be archived for 10 years or more, presenting a massive storage problem. Hard copies may take hours or days to retrieve, but Celebration Health's physicians will be able to view these images on workstations, speeding access and making it possible for immediate comparisons and prompt diagnoses. So, by taking advantage of the most advanced imaging and storage management solutions, Florida Hospital is actually letting patients and doctors get back to what they were trained to do: maintain the health of their patients and heal them when needed.