Going paperless and gaining efficiencies in the medical staff services and credentialing office
by Barbara A. Warstler, MBA, CPMSM, FASPR, director, University Hospitals Medical Staff Services and Credentialing; Lisa M. Zuppert, BA, CPMSM, manager, University Hospitals Enterprise Credentialing Information Systems; and Kevin Kelley, University Hospitals credentialing database administrator
How many stacks of papers are currently on your desk? How much time do you spend searching through mounds of paper looking for one specific document? How much time and money does your department spend preparing and mailing documents each month? How much time do you spend filing papers, printing documents, and preparing binders for your meetings? How much time do you spend stapling papers together, just to remove the staples later? Do you pride yourself on having the most colorful file folders in the hospital? As you reflect on these questions and maybe even chuckle at your responses to them, consider transitioning to a paperless office.
In healthcare today, we are all challenged to be more efficient, process credentialing files faster, leverage technology to work smarter, stretch our budgetary dollars, and achieve the highest possible results on accreditation audits and surveys—all while improving the patient experience and providing the highest quality of care. When contemplating the task of transitioning your office to a “less paper” or paperless environment, there are key elements to consider. This is a marathon, not a sprint. Transitioning to a paperless office takes time and requires you to think about your work in a different way.
Why go paperless? A paperless office:
• Reduces costs
• Increases efficiency
• Is environmentally responsible
• Reduces the time needed to file documents
• Increases the speed of processing credentialing files, especially in healthcare systems where documents can be shared between facilities
• Allows for sharing documents within a hospital or health system
• Is more organized thanks to easy document retrieval
• Reduces the amount of physical space needed for the department
• Allows for virtual work environments
• Provides more security for credentialing-related files and documents
• Allows for 24/7 access
• Provides robust audit trails
• Creates a less cluttered workspace
• Enables easier accreditation surveys and audits
The planning process
There are several considerations to keep in mind during the planning process toward becoming paperless.
• Start the planning process with the end in mind. Use organizations that have already become paperless as benchmarks. Learn from them. What went well with their transition process, and what could have gone better? Ask yourself what your organization’s paperless structure would look like. Keep in mind, each organization has different circumstances and objectives, so your paperless plan needs to reflect your organization’s strategic goals.
• Assess where to begin. How much of the paper is to be converted? How far back do you want to go in converting paper files? What should be done with the files after they are converted to digital images?At University Hospitals in Cleveland, we established a start date and scanned all current documents beginning from that date. Afterward, paper files were moved to off-site storage so they could be retrieved if needed in the future. Post-transition, we only create “paperless” files for our credentialing work. Consult applicable state laws when determining how to maintain or store credentialing files and other peer review documents.
• Determine a process for handling paper that comes in from vendors and customers. Will everyone on your team scan the documents that they receive? Will there be a reorganization of the team to create a position that is responsible for scanning everything?
• Determine the total cost for this project. How does going paperless fit into your budget, and what is the return on investment? What is the total cost of ownership for this project? Network with your colleagues in the finance department to help you justify this investment.
• Develop a timeline for implementation. What’s the proposed process for going paperless? Utilize flow diagrams to chart the process. Determine the milestones for the project and the time frame. Estimate the implementation time, then double it; it takes much longer than you think to scan and organize credentialing files electronically. Think long term, but start small. Consider what is needed in the future to maintain a paperless office, then start with a pilot project to work out the logistics.
• Consider the departmental organization. For larger organizations, consider developing teams. One team can focus on the credentialing issues, and a second can focus on the data: maintenance, reporting, and interfacing with other applications in the hospital or health system. For smaller organizations, determine if there are in-house resources to assist with scanning or electronic filing.
• Develop a feedback mechanism to keep practitioner data accurate. Gone are the days of keeping credentialing data in a dark filing cabinet, only pulling it out for review every two years during reappointment. In a paperless environment, demographic data can be shared throughout the health system. The more the data is shared and reviewed, the cleaner it becomes.
• Think about the future. How will the paperless process be maintained? Whose job will it be to scan incoming paper? Even after the initial scanning is done, there needs to be consideration for maintaining the new processes. Working in a paperless environment doesn’t lessen the work that needs to be done—it changes the work that needs to be done.
Software and technology
Confirm that tools are in place to support the paperless strategy. Do you have software that can accommodate a paperless system? Are there additional modules that need to be purchased to accomplish a paperless workflow? If credentialing software is not an option, can the IT department or a contractor build something internally? Also, consider using Adobe Acrobat Professional or an equivalent product so that documents can be made interactive, watermarked, and edited as needed during the credentialing process.
Additionally, there are several technology considerations to keep in mind while planning the transition to paperless. Check your existing computer hardware to make sure the paperless concept can be accommodated. Must-haves include adequate server storage, computers that can accommodate large digital files, multiple computer screens, and high-speed scanners.
Ask yourself how expensive new equipment or software would be. How can security be maintained for highly confidential documents? Is an electronic document management system going to be used, or is an internal index going to be created?
Setting up an internal indexing system correctly from the beginning can save time—and when you save time, you save money. To create one, begin by setting up an electronic file for each credentialed provider and arrange it like a traditional paper credentialing file. Create a standardized naming convention not only for each provider folder, but also for the name of each document contained in the folder.
Consider document retrieval while determining the setup of the files. Be sure to have a good backup system and build in redundancy so that if one file becomes corrupted, there exists an uncompromised replacement.
Since credentialing is a highly regulated industry, be sure that regulatory standards are adhered to, as well as applicable state and federal laws. It is critical that audit trails and security levels are built into the paperless program so that only those who have a business need to access and edit electronic files can do so. Partner with key people in your information services and technology department to assist you in these areas.
There are other tools that are needed to become paperless. Consider electronic faxing, which lets you stop using paper fax machines. Incoming faxes are converted to digital images and sent to individual email inboxes. Documents created with your computer can be sent to a fax machine via email or the Web. Electronic faxing is also more secure because paper copies cannot be lost or left on a fax machine for everyone to see. We recommend maintaining one paper fax machine in the department as part of the department’s downtime procedure when the inevitable IT issues happen. When selecting an electronic faxing system, be sure that faxes can be automatically forwarded to someone else’s email when the original recipient is out of the office for any length of time.
Rally the troops
Determine how the staff will be informed. Encourage them to buy into the process so they accept the changes you want and don’t slide back into heavy paper use. At University Hospitals, we kept our team engaged throughout the entire process. There was excitement and energy around the project. We were the first department in our health system to become paperless, and our team members are proud to be the paperless pioneers.
When securing help for the project, determine how much outside help you’ll need to complete it. Transitioning to a paperless process is a huge undertaking that will require resources to complete—and your current team already has a full-time workload. Consider using a document imaging company, a consultant, or temporary staff/interns to assist with the transition. A project like this could provide a valuable learning opportunity for college students, many of whom need internship hours to complete their educational program—and securing their assistance may be free or low-cost for you. Remember that training is essential for everyone participating in this project. Because of its size and scope, consistency is important.
Working virtually
Creating a paperless work environment will allow organizations to redefine how and where credentialing work is done. It opens up new possibilities for medical staff professionals, as well as practitioners. Work can be done from virtually anywhere. Consider work/life balance: Roll out of bed, turn on your computer, and start working. Throw in a load of laundry between emails. You no longer have to run into the office to do something; you can do it from home, or from the beach—wherever you have Internet access.
Working virtually allows for flexing your schedule for “life stuff” so that vacation time can be spent enjoying yourself. This also enables MSPs to cover multiple offices at the same time. You can be creative with your work schedule—you don’t have to think of your office hours as 9–5, Monday through Friday. You can conduct and participate in virtual paperless meetings. You can meet with practitioners or other staff members via a webcam or a virtual meeting place. It is also possible to be connected to your office telephone via your computer. This allows customers to contact you at one number, wherever you are. Practitioners can work virtually too, completing their applications online. The benefits to all involved are endless.
The overall beauty of developing a “less paper” or paperless office environment is that you can develop and implement what works best for your operation; you can evaluate the entire process and make adjustments as necessary. This is an evolutionary process and will change over time—the hardest part, as with any change, is getting started.