Small critical access hospitals typically associate themselves with a larger, tertiary facility. In 2003, a tertiary hospital that ran Siemens Medical Solutions’ MedSeries4 healthcare information system on the IBM i (formerly i5/OS and OS/400) operating system decided to switch to a new platform. This presented the associated community hospitals with a problem. They didn’t want to switch from MedSeries4 and IBM i, but that meant they would have to assume responsibility for their own data centers.
Fortunately, a solution presented itself. A local hospital management company agreed to create a new data center to assume responsibility for managing the community hospitals’ system if the hospitals would sign a contract to use those services. With this agreement in place, Hays, Kansas-based Midwest Health System (MHS) Data Center was born. Today, MHS Data Center supports 29 rural hospitals in Kansas and Nebraska with a total of 650 acute care beds.
To say the least, managing healthcare billing can be a major challenge for hospitals. Myriad insurance companies, including Medicare and Medicaid, each have their own complex documentation requirements and precise specifications as to which medical tests, procedures and medications are covered under which conditions. “And it’s getting more impossible every day,” declared Kenneth Abendshien, director of information systems at MHS Data Center. Consequently, “In small communities, you don’t just put an ad in the paper saying ‘I need hospital biller’ and expect anyone with the necessary experience to apply.”
To overcome this skills challenge and to achieve other efficiencies, MHS centralized the billing function for all of its hospitals, but this created another challenge. When a patient registers at one of the hospitals his or her current health insurance card must be compared to the card, if any, that is on file. If necessary, a new copy must be created and stored. The problem is that patients present their cards at the local hospital, but the remote central billing office needs immediate access to the information on those cards. A system that stores electronic document images and makes them instantly available over a network could solve theproblem, but MHS Data Center had a few requirements for any such system.
First, because the data center was very satisfied with the manageability, scalability and upgradeability of IBM i, the document management system had to be IBM i-based. Second, it had to be able to integrate easily with MedSeries4 to capture and store patient registration and insurance data.
Third, because the community hospitals have at most one technical person on staff and often not even that, the desktop portion of the software had to be easy to install and use. Fourth, because registration clerks at small community hospitals don’t have a lot of experience with complicated insurance requirements, MHS wanted a system that could automate workflows to ensure that the clerks met those requirements.
Fifth, because those same clerks don’t often have a lot of experience scanning and indexing documents, it was important that the system was easy to use and required little training. And sixth, because MHS, like all organizations that deal with health information, is bound by the very strict privacy and data security regulations of HIPAA, the software had to have strong access control mechanisms. MHS Data Center fulfilled its requirements with Webdocs from Fortra.
Achieving Centralized Billing and Document Imaging with Webdocs
Webdocs, which is available in versions that run on Microsoft Windows-based and IBM i-based servers, allows organizations to scan and electronically store and manage document images and other files, such as PC files, emails and computergenerated reports. The documents can then be accessed using up to 10 index keys or through a full-text search. When the documents are stored, the keys can be entered manually or Webdocs can automatically extract them from barcodes or textual data appearing within the images.
Once loaded into the system, authorized personnel can use a standard Web browser to access the images over the Internet from anywhere in the world. Webdocs was not the only option that MHS Data Center considered. It also looked at an offering from an Application Service Provider (ASP). When the data center asked the ASP if it could fulfill MHS’ automated workflow requirements, the response was, “no problem.”
But reality fell short of the promises. The ASP could automate some of the workflow steps, but not all of them. Another problem was that the ASP would have stored MHS’ documents on its systems. Consequently, the integration of the document management functionality with the MedSeries4 application would not have been as tight as the data center wanted. MHS Data Center evaluated an IBM i-based document management application from another vendor, but the data center wasn’t comfortable with the workflow capabilities of that product.
MHS Data Center then asked its IT business partner, MSI Systems Integrators, if it knew of a solution that would meet MHS’ requirements. MSI suggested Webdocs. Installation of the server portion of Webdocs was trivial. MHS Data Center provided Fortra with a tunnel into the data center’s computer. Fortra then downloaded, installed and configured the software. The implementation was completed in a single afternoon, without any impact on MHS’ ongoing operations. The hospitals were responsible for installing the desktop portion of the software. Because the hospitals use a variety of installation methodologies and the level of technical skills varies from hospital to hospital, a few issues arose during the desktop installations. Fortra resolved those issues quickly.
“The Fortra helpdesk people were very helpful,” declared Abendshien. “They usually resolved our questions during the first call. They’ve been wonderful.” To automate workflow processes, MHS Data Center and Fortra took advantage of an exit point in the patient registration component of the MedSeries4 application. When registering a patient, the system now links seamlessly with Webdocs to show the registration clerk the most recent heath insurance card image on file. The clerk is required to verify that the image matches the patient’s current card. If not, the system requires the clerk to scan the new card, which is automatically indexed by Webdocs, before registration can continue.
All of this happens within MedSeries4 without the clerk needing to manually launch a separate application, which is something that the ASP was unable to offer. Results A central billing office has allowed MHS to attract and retain a higher caliber of healthcare billing specialist than most of the individual community hospitals could have recruited on their own. Abendshien reports that the central billing office would not have been possible without a document imaging solution like Webdocs.
Being able to run Webdocs on IBM i is a definite plus for MHS Data Center. It has been running the Siemens software for about 20 years, spanning five generations of the systems that, over that time, have been called AS/400, iSeries, System i and now Power Systems IBM i edition. When moving from one generation to another, the Siemens software never had to be reinstalled. “You can’t say that with Windows or UNIX,” noted Abendshien. “With them, it’s a monumental upgrade to go from one generation to the next. That’s not so with iSeries.” Abendshien looks forward to the same level of stability and reliability for Webdocs on IBM i.
Running Webdocs on IBM i has also simplified security for both the data center and the users of the system—security that is mandatory because of HIPAA. Because Webdocs employs IBM i user profiles and authentication, authorized users can access both Webdocs and other applications with a single sign-on. And the data center didn’t need to implement any tricky interfaces to make that happen—it came naturally. MHS Data Center has found Webdocs to be a cost-effective solution. The alternatives that the data center looked at required the licensing of expensive workstation software, but Fortra offered unlimited licensing of the desktop portion of Webdocs. This resulted in a significantly lower total cost of ownership.
At the time of writing MHS Data Center had been using Webdocs for only four months, but it had already found other uses for the solution. The data center had been storing its operations manuals on Microsoft Office SharePoint, but it was experiencing problems providing some hospitals with access to those documents. The data center has since moved the documentation from SharePoint to Webdocs. Now, access from all locations is easy. One MHS hospital is also experimenting with loading old health records into Webdocs to make electronic images of those records easily accessible to authorized personnel.
In addition, the data center is working with Fortra to look at using Webdocs to automate pharmacy workflows at the hospitals. And Abendshien expects that as MHS Data Center gains more experience with Webdocs it will find other value-enhancing uses for Webdocs.