HEALTHCARE

engage. empower. evolve.™

engage. empower. evolve.™

Healthcare providers face intense economic, regulatory and competitive pressures. To thrive, organizations must deliver high quality patient care while lowering operational costs. With the knowledge gained from more than 4,700 customer organizations, OnBase was developed by Hyland Software to help organizations do just that.

OnBase Healthcare Solutions enable hospitals, clinics and integrated delivery network settings to create competitive advantage through reduced costs, streamlined operations, compliance assistance and, ultimately, increased overall patient satisfaction. The flexibility of the OnBase solution accommodates each provider’s specific needs.

Hyland Software and its partners have extensive experience in the healthcare industry, making the transition to an enterprise content management solution a smooth process for any organization. By digitizing, standardizing and automating your processes, OnBase Healthcare Solutions enable your organization to run more efficiently and cost-effectively

by streamlining workflows across the enterprise with point solutions in the following areas:

• Revenue Cycle Management - Registration - Patient Accounting - Coding• Medical Records - Health Information Management -EMR Augmentation• Back Office Operations - Accounting - Human Resources - Compliance Assistance

OnBase Healthcare Solutions are built using OnBase software, a configurable, scaleable enterprise content management (ECM) application that can be deployed to meet your organization’s specific content and process requirements now and into the future. The open architecture of the system enables integration with your EMR, HIS, PMS, AP/AR, HR and PACS systems to fully leverage their capabilities and achieve rapid payback on your technology expenditures.

Document Management for the Healthcare Enterprise

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Once viewed as a “bolt-on” technology – addressing only the needs of a single department and lacking the functionality and scalability to be leveraged across the enterprise – document management is playing a much more vital role throughout the healthcare provider enterprise. Taking a more strategic approach, an increasing number of hospitals are addressing their document and content management needs as an enterprise infrastructure, rather than be faced with supporting three or four different solutions that meet the needs of individual departments.

OnBase Healthcare Solutions provide robust point solutions for revenue

DOCUMENT MANAGEMENT - AN ENTERPRISE SOLUTION

cycle management, medical records and back office operations (e.g., human resources, accounting) with the scalability required to serve as a single document management infrastructure for the provider enterprise.

Much more than a scanning solution, OnBase manages virtually all of the diverse “content” found across the enterprise. OnBase captures, stores and manages scanned images, faxes, reports from core line-of-business applications, e-mails (and attachments), application files such as Word™ or Excel™ documents, HL7 data, electronic forms, HIPAA ANSI X.12 835 and 837 files, and more. In addition, with

integrated workflow, OnBase streamlines or even automates your document-centric processes throughout the organization.

Near ly 500 hea l thcare prov ider organizations representing more than 1,000 facilities utilize OnBase for the secure storage, retrieval and business process management of their documents. OnBase Healthcare Solutions focus on three key areas: Revenue Cycle Management, Medical Records and Back Office Operations.

RegistrationThe burden of paper associated with patient registration continues to grow. Registration staff must capture the correct documents, often multiple times, and failure to do so can have dramatic impacts - from insurance denials to patient safety.

OnBase Front Office Scanning enables registration personnel to quickly scan and capture patient documents (e.g., driver’s licenses, insurance cards, consent forms, privacy notice acknowledgements, ABNs, DNR forms, etc.) without leaving their desks or their patients. Once scanned, those documents need to be “indexed” or assigned keyword values. OnBase eliminates the need to manually enter index values by utilizing information directly from the patient’s registration screen or HL7 ADT information. Configurable rules allow specific document types to be required, preventing staff from completing scanning until all required types have been captured. Additionally, registration personnel will have access to documents already on file, allowing them to forego rescanning information already captured, such as an insurance card scanned during the previous visit.

Front Office Scanning also can be deployed in a “centralized” mode, providing the same functionality and benefits previously mentioned but utilizing a single scanning station instead of a scanner at each desk. An emergency room that uses mobile laptops on carts for registration is a prime example of a centralized deployment. Once a patient is registered on the bedside laptop, the documents are captured at the centralized scanning station where the information previously entered on the cart will be present. Once scanning is complete, the patient file is available for viewing by authorized users throughout the organization.

Key Benefits for Registration• Reduces paper, paper storage, photocopying and faxing costs• Ensures the proper documentation is captured• Eliminates the need to gather documentation from patients already current in the system• Streamlines compliance driven documentation requirements• Initiates automated revenue cycle processing

REVENUE CYCLE MANANGEMENT

Many providers still are trying to deal with a deluge of paper EOB remits. Whether housed in cabinets onsite, at offsite storage or with pick-up and delivery storage services, the bottom line is that retrieval times for remits needed to answer questions from patients and providers, as well as handling denial follow-up and secondary billing, are frustratingly long. The nature of these remits, sometimes hundreds of pages long and with multiple patients on each page, compound the problem as they typically are filed by posting date and organized by batches and/or insurance carrier names, making them difficult to search at the patient-level. More frustrating is that the promise of HIPAA and electronic remits nets significant savings associated with the time to post, as ERAs post automatically. However, downstream business processes still require significant paper production and interaction along with the rest of the paper EOBs received.

Providers utilize OnBase to capture, store and retrieve EOBs, whether received via paper or in the electronic HIPAA ANSI X.12 835 format. OnBase Document Imaging is used to scan paper EOBs. Users have the flexibility to index at the batch- or patient-level. Electronic remits received in the HIPAA standard ANSI X.12 835 format are captured and stored with the OnBase 835 Processor. EOBs processed through the 835 Processor are parsed into individual patient transaction EOB documents with a single patient transaction on each page, automatically indexed and searchable at a patient-level.

Once in the OnBase system, EOBs are immediately available to authorized individuals throughout the healthcare enterprise via several retrieval mechanisms. The OnBase Application Enabler integrates OnBase with the existing billing system, allowing patient accounting personnel to access EOBs directly from the billing system. Users simply double-click on a designated field or hit a Function Key within the billing system application to

retrieve the EOB from OnBase and bring it up onscreen beside the billing application. This alleviates the need for end users to switch between software applications, virtually eliminating any learning curve associated with the use of document management in the patient accounting environment.

OnBase COLD/ERM (computer output to laser disk or enterprise report management) provides additional opportunities for efficiencies in the patient accounting area. COLD/ERM automatically captures and stores electronic data streams from the billing system and other core applications. COLD documents typically are captured and automatically indexed into the system via a scheduled process, requiring no human intervention. Providers use COLD to capture and store HCFAs, UB92, patient billing statements, close reports, aged receivable reports, etc. Patient accounting personnel reviewing an account with a patient on the phone would now have the claim, in addition to the remit, at their fingertips to assist in answering the patient’s questions.

Beyond the savings associated with digital storage and retrieval, OnBase provides further efficiencies by managing the processes associated with those documents. OnBase Workflow provides document-centric business process management, automatically routing documents and work according to defined business processes. Secondary billing and denials management are areas where Workflow can increase process efficiency.

Combining the OnBase technologies of COLD, Imaging, the 835 Processor and Workflow, secondary claims generated by the billing application automatically can be processed into OnBase without scanning or indexing and matched to the primary electronic remit/EOB received for that patient. The secondary claim and primary EOB can be merged together as a single document and sent to the printer

for secondary filing. This alleviates the need for staff to make a copy of the primary EOB and then “black out” other patients’ information on an EOB page where multiple patients are present.

Utilizing denial codes from the remit, OnBase Workflow automatically can route these remits based on the hospital’s business rules for each denial code type. For example, a claim denied for missing documentation can be routed to the appropriate department to provide necessary supporting documentation. The claim would then be routed back for resubmission to the carrier with all appropriate documentation attached.

User-defined and point-and-click configurable, OnBase Workflow utilizes a concept of rules and actions. For each rule, there is an associated action or set of actions. For each denial code, there is an action that is taken, such as automatically routing the document back to the originating department.

Key Benefits for Patient Accounting• Provides faster responses to patient

and provider questions with instant access to patient-level EOBs

• Streamlines denial follow-up and secondary billing times

• Reduces costs associated with paper EOB storage

• Enables EOB access directly from billing system - shortening the learning curve and increasing user

acceptance• Handles electronic remittance advice

in HIPAA 835 format

Patient Accounting

REVENUE CYCLE MANANGEMENT (cont.)

Key Benefits for Coding• Streamlines coding process with

rules-based Workflow• Coder worklists prioritized based on

date of service, charge information, type of denial

• Eliminates re-work done on deficient charts

• Adds efficiency and employee retention with remote coding

• Enables productivity tracking and accountability, ensuring turnaround requirements are always met

• Facilitates HIPAA compliance• Improves patient safety with

instant, simultaneous viewing of chart information

aging charts, charts awaiting completion prior to coding or charts with large revenue opportunities, thus preventing charts from getting “lost in the shuffle.”

OnBase Workflow can be securely deployed via a thick client, thin client and Citrix®. Thin client as well as Citrix deployments allow users the flexibility to have coders work remotely, as well as from their homes, without the need for an outsourced ASP hosted implementation. This flexibility can be a key component as organizations are continually challenged with hiring and retaining coding staff.

Coders interacting with OnBase may do so through a customizable viewer that allows them to interact with the chart information and their encoder software from companies such as 3M and HSS, Inc., or directly with the billing system, often in a side-by-side environment.

By interacting electronically with the documents for coding, OnBase will provide productivity tracking and accountability not previously possible in most manual environments. From the moment a chart or summary enters OnBase it is tracked. Tracking is done at a user level, with time metrics that allow organizations to create productivity reports. In addition, each time a document is accessed or manipulated in any way, i.e., printed, annotated, etc., an audit trail is created, assisting with HIPAA mandates requiring audit trails for all individually identifiable health information.

Documents stored in the OnBase system are simultaneously accessible. Based on user-defined security, charts being worked by coders are accessible to other users throughout the hospital. In a manual/paper-based environment, a patient chart being coded would need to be tracked, located and returned or copied should that patient return for additional treatment. With OnBase, that chart will be available instantly by clinicians for secure viewing, while the coder continues processing through OnBase Workflow, increasing the efficiency of the coding process while improving patient safety.

CodingWith narrowing profit margins and increasing salaries of highly specialized coding professionals, medical coding efficiency and accuracy is paramount. However, reliance on paper-based documentation and manual processing is prone to time consuming delays and errors.

By digitizing documentation and standardizing the process, OnBase Workflow streamlines coding and improves accuracy; which, in turn, reduces days in A/R and increases cash flow.

Often, chart information may reach a coder in a deficient state, requiring the coder to wait for the information or set aside the chart to request the necessary documentation. If paper-based, the document in question may not easily be retrieved. Inevitably, the coder will move on to another chart having wasted valuable time.

OnBase Workflow applies rules-based routing to the coding process. Coder “worklists” can be created, sorting by rules such as “oldest first.” Additionally, data provided from the billing system could allow for worklist sorting by charge information.

Provider organizations can pre-determine which documents must be present prior to having them electronically routed to the coder worklist. OnBase polls the system, automatically checking for the required document(s). Once all related documents are present, the documents for that patient episode will be consolidated and placed in a worklist for coding review. Incomplete charts are held by the system in a “pending” queue, awaiting all required documents. Timers can be set to trigger events while waiting for missing documents. For example, if the transcription has not arrived 24 hours after receiving the ER Chart and Discharge Summary, OnBase Workflow automatically can send an e-mail notification to the Transcription Department requesting the report. E-mails additionally can be sent to coding supervisors, etc., to raise awareness of

REVENUE CYCLE MANANGEMENT (cont.)

Document Lifecycle

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With the federal government’s push toward the adoption of a ubiquitous electronic health record and the continual increase of costs associated with storing, securing, managing and distributing patient charts, providers must look for ways to be electronic. However, the costs and culture changes associated with adopting an EMR (electronic medical records) system can be prohibitive for many hospitals and physician practices. Even so, the consensus among providers is that the need to be electronic is imminent.

The OnBase Medical Records Viewer gives those providers that currently are unable or unready to purchase an EMR system the opportunity to digitize patient charts. The Medical Records Viewer is a web-based presentation built on the Microsoft® .NET platform that takes medical record information stored in the OnBase system and presents it in a tabular, longitudinal view that looks and reacts like a paper chart. Because of its chart-like look and feel, the Medical Records Viewer alleviates many of the cultural boundaries associated with moving to an electronic

patient chart. Additionally, for those providers that already have adopted an EMR, the OnBase Medical Records Viewer can be utilized in conjunction with those systems for the presentation of documents unable to be stored directly in the EMR (e.g., externally created paper documents such as labs and consults). Organizations planning to adopt an EMR in the future also can benefit from the OnBase Medical Records Viewer. Scanning, storing and working with digital chart information in the OnBase system will not only provide significant efficiencies but also will ease the transition process to a full-blown EMR. And, because OnBase can be easily integrated with third party applications, the documents stored in the OnBase system would be accessible immediately upon implementing an EMR system, without the need for a costly conversion.

As a fully integrated feature of the OnBase enterprise content management solution, the OnBase Medical Records Viewer can be used in concert with other OnBase modules (e.g., Workflow and Electronic Signatures) to provide HIM departments

with the tools needed to streamline processes such as chart completion and release of information. Workflow digitally routes chart work – with the look and feel of current paper versions – to physicians for review and signature. OnBase Web Server provides physicians with the ability to securely view and sign off on chart work virtually anywhere via the Internet. For Release of Information, OnBase also automatically groups together and prints needed documents, further easing the burden traditionally associated with paper chart information.

Key Benefits for HIM• Provides simultaneous access to

patient information across the provider enterprise

• Enables providers not ready or financially able to adopt an EMR with the ability to digitize patient charts

• E a s e s the t rans i t i on when implementing an EMR

• Chart-like presentation eases clinician acceptance

• C re a t i on o f shadow cha r t s eliminated

MEDICAL RECORDS

Health Information Management (HIM)

Augmenting EMRsProviders that have implemented an EMR still must deal with externally generated documents that cannot be managed through their EMR. Because of these documents, providers must continue to maintain a paper chart, albeit smaller, for every patient.

OnBase provides the necessary bridge between externally generated documents and the EMR which allows providers to achieve a true electronic health record for their patients. Supporting a variety of integration methodologies, including HL7 as well as API, OnBase enables clinicians to work with virtually any EMR as a single, seamless interface to all patient chart information. Examples of EMRs that OnBase integrates with include

EpicCare from Epic Systems Corporation and Logician® from GE Healthcare.

Paper documents, traditionally stored in a paper-based chart, are scanned and stored in the OnBase system. OnBase notifies the EMR when new documents are stored, what type of documents they are and for which patient. This information is used then by the EMR to “map” the document location in OnBase to the appropriate location in the EMR interface (e.g., orders, results, etc.). Scanning can be done in batch-mode to create economies of scale. Or, if supported by the EMR, a “point of care”-scan can be performed, allowing the user to scan “in context,” thus alleviating the need for indexing the scanned documents. OnBase supports

the updating of an EMR regardless of the method (COLD, document import, scanning, etc.) used to bring documents into the OnBase system.

Key Benefits for Augmenting EMRs• Provides electronic storage and

presentation of documents unable to be managed by an EMR

• Presents single, seamless interface to patient information through EMR interface

• Automatically updates EMR when documents are added to OnBase

• Facilitates HIPAA compliance• Allows provider to fully leverage EMR

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MEDICAL RECORDS (cont.)

meet compliance requirements and minimize the costs associated with doing so. By digitizing content, organizing and controlling document delivery and standardizing processes, OnBase assists providers with a variety of compliance initiatives, including:

• Health Insurance Portability and Accountability Act (HIPAA);

• Joint Commission on Accreditation of Healthcare Organizations (JCAHO);

• Sarbanes-Oxley Act of 2002 (SOX);• medical coding compliance; and• human resources.

Because it is both scalable and modular, OnBase can be incrementally, cost-effectively expanded and enhanced to meet a provider’s specific needs. By implementing a single solution that meets both core business requirements and regulatory needs, OnBase minimizes an organization’s risk as well as reduces the cost of implementation, administration and training.

BACK OFFICE OPERATIONS

In today’s provider environment, operating at optimal efficiency is paramount. Back office operations, such as accounts payable, human resources and compliance, certainly are no exception. OnBase allows providers to automate back office operations, reduce costs and create competitive advantage.

OnBase empowers organizations to manage and route the documents associated with these operations throughout an organization electronically, regardless of location. Using the workflow capabilities of OnBase, documents are routed to users in accordance with established business rules, thus mimicking the existing paper-based processes. As a result of rules-based processing and movement of documents through an organization, the time spent performing low-value manual tasks involved with the physical filing and handling of paper is significantly reduced, freeing employees to spend time in functions that contribute more value to the business.

The open architecture of the system enables seamless integration with existing back office software applications to fully leverage their capabilities as well as maximize user acceptance and minimize the burden put on IT staff.

Accounts PayableThe costs and inefficiencies associated with paper can cause bottlenecks in the accounts payable (AP) process. Often overlooked from a technology standpoint, inefficient AP processes can certainly cost provider organizations above and beyond payable amounts, from lost discounts, late payment penalties and duplicate payments to misappropriated expense handling.

OnBase can be utilized to increase processing efficiency, accuracy and costs associated with:

• requisition submission;• purchase order handling; • invoice processing and approval;• customer service; and• expense report management and

payment.

Human ResourcesHospitals, often a region’s largest employer, must become increasingly efficient at managing their human resource functions. Attracting, selecting, retaining and developing human resources in large and decentralized organizations can be a challenging task. OnBase streamlines the effort and resources required to manage these functions.

OnBase captures and stores employee records, as well as documents associated with credentialing, recruitment, testing, relocation, continuing education, benefits administration and compliance. In addition, OnBase also provides the ability for employee self-service to employment-related documents.

OnBase increases human resource employee productivity and reduces costs by streamlining employee administration and automating critical processes such as recruitment and selection, placement, performance evaluations, compensation plan changes, time-off requests and the associated approval processes.

In addition to these benefits, OnBase provides organizations with the ability to:

• reduce time performing routine functions such as changing name and address data, entering vacation dates and filing and retrieving employee records;

• automate routing and distribution of documents requiring approval; and

• reduce storage costs and virtually eliminate any document loss by providing a central repository for all records.

ComplianceHealthcare organizations are faced with an increasing number of compliance and governance mandates. They must find ways to satisfy these requirements while keeping costs under control.

The OnBase ente rp r i se content management solution supplies healthcare providers with the tools needed to

Hyland Software, established in 1991, is a leading provider of rapidly deployable enterprise content management software. Hyland develops OnBase, enterprise-class software that combines integrated document management, business process management and records management in a single application. OnBase allows organizations to manage digital content, including scanned paper documents, faxes, print streams, application files, electronic forms, web content, multi-media files and e-mails. OnBase also authorizes organizations to automate business processes, reduce the time and cost of performing important business functions, improve organizational efficiency and address the need for regulatory compliance through the management, control and sharing of digital content with employees, business partners, customers and other constituencies. Visit www.onbase.com for more information.

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