GROVE HILL MEDICAL USES CAPELLA TECHNOLOGIES FORMPORT SERVER TO UPDATE PATIENT INFO FORMS PRINTING PRINTING SOLUTION SAVES TIME & MONEY FOR HEALTHCARE PROVIDER Grove Hill Medical Center, the largest multi-specialty clinic in Connecticut, was moving 200,000 patients to a new patient management system, but had a problem with its patient encounter forms. These vital formatted documents contain blank fields that office staff fills in with information about services provided and charges incurred each time a patient visits the healthcare provider. At Grove Hill, the problem with the patient encounter forms had to do with paper too much of it. The multi-department/multi-location Grove Hill, operated by more than 70 physicians representing more than 19 specialties, participates in most insurance plans, HMOs and PPOs. The healthcare provider uses between 20-25 different patient encounter forms, depending on the medical specialty involved. Their total amount of pre-printed forms in use had topped 400,000 pieces per year. The limitations of using pre-printed, multi-part, multi-page forms included: Long lead-time to develop the forms. Order-quantity minimums (the smallest amount is typically 5,000 units). Costs associated with purchasing, inventory, storing, bursting and distribution. Waste due to rapid forms obsolescence. To complicate matters, the forms were output onto noisy, inefficient, outmoded old-style dot matrix impact printers, which use columns of dot hammers that are moved across the paper, striking a ribbon against a page to form images out of dots. And since the encounter form is an important patient accounting document that details charges incurred for any and all medical services rendered during a visit, the outmoded forms made it difficult to fully and accurately capture billing charges at the point of patient contact. Moreover, the switch to a new forms output system had to take place smoothly within the context of the larger project of changing over to the new patient management system all without disruption of customer service or interruption of cash flow. CAPELLA SOLUTION FORMPORT SERVER The solution came from Capella Technologies, Inc., Irvine, Calif., a developer of enhanced printing products for HP LaserJet printers. Grove Hill decided to print its encounter forms in-house on plain paper using laser printers. They did it with Capella s FormPort Server software solution for HP LaserJet printers. FormPort Server is a comprehensive tool for customizing and merging raw data into professional-looking forms for direct output to selected printers, creating proprietary professional documents that are ready for immediate distribution. Today, updating encounter forms now takes Grove Hill staff minutes instead of hours or days, and the forms are printed when the staff needs them, in required quantities, while page costs are the same as for any laser-printed page. The cost of supporting the old dot matrix system was very high, and pre-printed forms are foolish and wasteful, said Carl Labbadia, Grove Hill IS director. The dot matrix printers were dedicated to forms output, so switching to LaserJet printers enabled us to eliminate the old printers in eight locations and share the laser printers because now we can print both encounter forms and standard documents like reports. Formport Server Success Story page 1
Grove Hill uses 60 HP LaserJet 1200 printers, and Labbadia indicated that the choice was simple. We use HP laser printers because I wouldn t consider using anything else, he declared. HP has a great product low cost, reliable, the best name in printers. And this isn t an issue of money. IBM did try to get in door, but we knew that going with HP was the right thing to do. In fact, after we finished the project, we determined that we paid less money for our printing solution, no question. Teaming HP LaserJets and Capella s FormPort Server has meant a major cost savings for Grove Hill, he said. Next up, we re working on Medicare forms, patient letters and labels. GROVE HILL MEDICAL CENTER Grove Hill is a 55-year-old physician-owned private corporation headquartered in New Britain, Conn., where it has five offices. Additional Connecticut locations include three in Southington and one each in Cromwell and Newington. Grove Hill healthcare specialties include: internal medicine, obstetrics and gynecology, cardiology and urology, pediatric and adolescent medicine, dermatology, ophthalmology (eye center), ear, nose, throat, orthopedic surgery and sports medicine, physical medicine and rehabilitation, endocrinology (diabetes), pulmonary medicine, gastroenterology, radiology, hematology/oncology and rheumatology services. In addition to physicians, Grove Hill end users who work with the information systems include practice managers, physicians assistants and data entry clerks. PATIENT MANAGEMENT SYSTEM For years, Grove Hill based its medical management system on IDX Systems Corp. s IDXtend, an integrated software suite for the financial and patient-management operations of healthcare organizations. IDX, Burlington, Vt., provides information technology solutions to healthcare providers. In September 2002, Grove Hill began upgrading its IT infrastructure. The older system had become too costly to maintain and we wanted to cut overhead, Labbadia explained. We needed a more efficient patient management system that would enable us to reduce operating costs on an annual basis. Grove Hill s computer network was a private Ethernet 10baseT LAN serving a 200-user dumb terminal environment with serial printing to dot-matrix printers. Labbadia s team which includes network engineer Rich McCabe and system analyst Yuriy Rogach first upgraded the network data transport protocol from frame relay to the clear-channel point-to-point connection method. IDXtend was hosted on an archaic Digital AlphaServer 2100 departmental system. They replaced the AlphaServer 2100 system with an IBM pseries (RS/6000) 620 Model 6F1 highperformance deskside server running IBM's AIX 5L Unix operating system. Then Grove Hill began transitioning from IDXtend to IDX s Groupcast practice management system (formerly known as GPMS ). Groupcast provides patient management, financial management and decision support solutions for mid- to larger-size group medical practices and physician service organizations. For managing encounter forms, IDX recommended Image XChange (IMX ), its ambulatory document management solution for transforming paper documents to an online format for quick retrieval. But Labbadia estimated that purchasing the IMX application, licensing the software and buying scanners would have cost Grove Hill nearly $120,000. Formport Server Success Story page 2
And the process of printing encounter forms and doing charge entry would have still necessitated the use of pre-printed forms that an outside vendor would have had to provide, he said. They also recommended that we use Cardiff Software s TELEform technology to convert the scanned forms. We wanted to get away from all that. So Labbadia did a Web search and located Capella Technologies. ENCOUNTER FORMS An encounter is a healthcare visit of any type by a person to a provider of care or services. At Grove Hill, a physician s office visit begins with the generation of an encounter form, which supplies management with information about services provided during each patient visit. In addition to displaying relevant patient data for use during the appointment (e.g., patient demographic and insurance information, allergies, existing health problems, prior medical procedures, etc.), the encounter form is an important patient accounting document. The encounter form details charges for any and all medical services rendered during the visit (e.g., lab tests, doctor fees for consultation, routine physical examinations, treatment or other procedures; the cost of medical goods such as bandages, drugs, medicines, hypodermic needles or supplies). In addition, the form contains information about patient due and insurance due balances, aging of overdue patient balances, the amount of the patient s co-pay (specified dollar amount that a patient must pay out-of-pocket for a specified service at the time the service is rendered), and related financial details. The physician makes appropriate notes on the encounter form, which then goes to a charge entry operator, who enters the data into the computer via keyboard. The charges are entered into the Grove Hill accounting system, and then a bill of charges is prepared and submitted. FORMPORT SERVER Capella s FormPort Server software provides a quick, programming-free method of replacing old impact printers and pre-printed forms with fast, high quality laser-printed forms. In October 2002, Grove Hill set up FormPort Server on an Intel-based IBM Netfinity (xseries) server running Microsoft s Windows NT OS. Capella technicians designed the first 20 forms, and Labbadia tested the product. By November 3, all the necessary encounter forms were ready and Grove Hill went live. In addition to eliminating pre-printed, multiple-part encounter forms, FormPort reduced printer noise and maintenance costs by eliminating most of the old dot matrix printers. CREATING FORMS FormPort Server works by integrating FormPort Print Logic into the Windows NT server environment to add functionality to the server operating system's standard spooler software. As FormPort Server s print engine, FormPort Print Logic performs all the data processing tasks required for manipulating and reformatting text output. It supports data output from the UNIX host via a TCP/IP link. When the host application outputs a data file, FormPort Print Logic converts the data into fully formatted documents and sends the formatted data to a printer. FormPort Print Logic gives network administrators the ability to install FormPort-enabled printers on the server as logical printers rather than as physical printers. A logical printer is a software interface that resides on the print server between the operating system and network printers and allows one physical printer to be used as numerous virtual (simulated) printers, each with customized features. FormPort Print Logic gives users the ability to control multiple FormPort printer profiles through one logical printer. Formport Server Success Story page 3
When printing encounter forms, Grove Hill staff selects the forms logical printer, and FormPort Server customizes the document accordingly. After automatically formatting the data, FormPort Server monitors the logical printer to determine how the print job is processed and how it is routed to its destination (e.g., to a local or network port, to a file, or to a remote print share). If the form is to be printed, FormPort Server outputs the file on the appropriate physical printer. Because FormPort catches the whole data stream we can avoid any monitoring or management problems, Labbadia noted. FormPort Server isn t dependent on a single operating system, so it s very clean and flexible for our purposes. Document formatting is only the most basic functionality offered by FormPort Server. A number of optional FormPort Server agents (software elements that drive a process on a print job) can extend FormPort capabilities and help Grove Hill direct, manage and archive their document output. For example, the FormPort Server FTP agent enables users to automatically upload documents to FTP sites (computer systems in a network or on the Internet that maintain files for downloading) in PDF format or PCL/TIFF format. On a nightly basis, Grove Hill prints from the RS/6000 system 16-20 cash in/cash out reports that summarize for the 70 owner-physicians the medical center s total charges for the day. Then we use the FTP function to automatically upload these reports so that our physicians can access them at their convenience, Labbadia said. COMPETITIVE CHALLENGES As Connecticut s largest multi-specialty clinic, Grove Hill has no direct competitors, but, according to Labbadia, the center does have to respond to market pressures such as rising costs, smaller reimbursements and the doubling of malpractice insurance premiums. Enhancing patient care and substantially improving business performance is a Grove Hills motto. The challenge we face is how to keep costs low enough to stay in business, said Labbadia. We want to keep driving our overhead down while giving better care to our patients. Since the insurances are paying less, we have to do more with less to better serve our patients. That s why we needed this FormPort Server solution. We didn t need to invest elsewhere. Our doctors want to give good care and not take a beating doing it, which is why we need to find companies with products like Capella s that help us do that. SUCCESS FACTORS Success for Grove Hill s forms update project began with the IT team s efforts to fit the minor project of updating the encounter forms process into the major project of updating the Grove Hill s IT infrastructure. Properly planning the process and then communicating expectations was the basis for our successful transition, Labbadia said. We needed to convert without disrupting patient services or causing a dip in cash flow. In addition, he cited determination on the IT team s part to replace pre-printed forms with in-house laser printed forms. Not only was it important to find a fantastic partner like Capella that had the technical solution, it was equally important that they worked with us so closely to implement it, he said. Our biggest fear was that we d go to a third-party solution and it would suddenly stop working. In addition to closely collaborating with Capella representatives to set up FormPort Server, Labbadia made sure that he had redundancy at the server level. We had two machines running, one for execution and the other for backup, just in case things didn t go smoothly. We never needed the backup. Since November, FormPort Server has been working without a hitch, according to Labbadia. This thing is solid, this thing runs. We rarely look at. Every patient who comes in to a Formport Server Success Story page 4
Grove Hill Medical Center location has an encounter form, and is affected by Capella. Planning, redundancy, a comfort level with Capella s technical staff, who helped us with formatting issues and knew our deadlines these were the things that made our FormPort Server application work. 3 OLDFIELD, SUITE 100 IRVINE, CALIFORNIA USA 92618 PHONE: 949 597-0402 FAX: 949 Formport 587-9270 Server Success Story page 5