Challenge
Terri Andrews, RN, MBA, Clinical Systems Manager at ARMC, was part of a hospital-wide task force that examines where paper is being used and finds ways to replace it with an electronic solution. Andrews discovered that ARMC was still using paper consent forms in patient access and saw the need to replace it with an electronic solution. Alamance had 9 consents that had to be filled and signed by patients including:
• Advanced Beneficiary Notice (ABN)
• Consent
• Elon Release
• HIPAA Privacy Practices
• Important Message from Medicare
• Important Message from CHAMPUS
• Insurance Liability Waiver
• Patient Directory
• Procedure Denial

Going paperless was more about operating efficiency than anything else,“ says Jesse Long, CIO of ARMC. ARMC looked at several solutions, including digital pen. Because ARMC has both Eclipsys Clinical Manager and Siemens Document Imaging, registrars had to scan completed forms into both EMRs which wasted time. ARMC was also moving primarily to bedside registration in the ER, requiring a solution that was mobile and didn’t require the registrars to carry around a lot of paper on their computer on wheels (COWs). “We had paper forms all over the place and it was difficult to keep track of which forms had been signed by the patient,” explains Andrews. “Scanning forms was really time intensive. Additionally, documents were misplaced or lost and not entered into the EMR until much later.” ARMC estimated a 5% failure rate.

Andrews recognized that the tablet was a perfect form factor and began researching software vendors that were using the tablet for this purpose.

Solution
ARMC chose Logical Ink™ from Logical Progression, a healthcare software company based in Cary, NC that specializes in electronic charting solutions. The Logical Ink solution gave ARMC a platform for e-forms workflow, utilizing handwriting recognition to provide a natural, pen and paper interface for data collection. Logical Progression partnered with Fujitsu to provide ARMC with a slate form factor that would give them the largest screen size, battery life and a mobile form factor for patient satisfaction.

Logical Progression implemented its Logical Ink Forms Kiosk solution for ARMC to enable forms to be completed on the tablet and automatically synchronized with the ARMC Siemens EDM and Eclypsis EMR.

First, Logical Progression converted all 9 consent forms into electronic templates with its forms design tool. An HL7 interface for the Logical Ink Server was implemented to accept an ADT feed from ARMC’s Siemens MedSeries 4 HIS. Workflow rules were built to automatically build an electronic packet for the patient based on insurance type, service and primary language, as well as pre-fill the form templates with demographic information. Custom validation rules were implemented for each form template to highlight required fields for the patient, as well as keep the registrar from saving an incomplete form.

ARMC deployed the Logical Ink smart-client on 20 tablets. The initial go-live was limited to the inpatient/outpatient areas and then a week later ARMC rolled it into the ED. Each registrar has a tablet and after looking up the patient, they have the patient read and complete each form. To search for a patient, users simply ink the last name or account number. They can override the workflow rules by selecting from a list of forms. Forms are available in both English and Spanish, resulting in an improved patient experience. The software walks the patient through the process with color highlights for required fields and validation rules to ensure all required information is completed before the patient is registered. Registrars can easily review the packet for validation errors before completing check-in and sending the form images to both Siemens and Eclipsys EMRs where they are indexed automatically.

Results
ARMC has been using the solution since August 2007. They estimate the admission process has been cut by 5 minutes per
patient using the Logical Ink solution.

“We’ve eliminated a step in the process for our registrars,” says Bunnie Overby, Director of Patient Financial Service for ARMC. “Registrars no longer have to scan paper consents into Siemens Document Imaging and Medical Records no longer has to scan charts into Eclipsys Clinical Record.”

"Case Management is able to get to the documents more easily now through Sunrise Record Manager to confirm that the patient signed each consent.”

“We are very impressed with our new tablet PC solution and with our partners in this project, Logical Progression. Both the staff and the patients love the solution and the support we’ve received has been fantastic” says Overby.

Future Plans
Now that Logical Progression has implemented electronic consents for ARMC, Overby is planning to use the Logical Ink solution in other areas of the hospital like rehab and the cancer center. They’ve ordered devices for decentralized, offsite areas such as rehab and cancer center. The next phase is to implement procedure consents on the floors for when a patient needs to sign a consent in the OR.

Benefits

Technology

• Siemens MedSeries 4 HIS
• Siemens Document Imaging and Eclipsys Sunrise Clinical Manager EMRs
• Logical Ink Forms Kiosk
• Microsoft .NET and SQL Server 2005
• Fujitsu ST 5112 Tablet PC

About Logical Progression
Logical Progression is a software company specializing in tablet-based charting solutions and healthcare interfacing solutions. With over 20 years of experience in healthcare, mobile data capture and electronic forms, Logical Progression is an innovator in the healthcare tablet PC market, building ink-friendly and intuitive user experiences. Logical Ink, the company’s core product, is a mobile data collection solution for healthcare that generates an electronic chart of forms pre-filled via HL7 and seamlessly integrates with the EMR without redundant data entry or form scanning. The company is based in Cary, NC. For more information, visit www.logicalink.com.

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