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Document Imaging for a County Board Jonathan Zuhosky, FCBDD SSA Records Manager

OUTLINE

•  Things to think about when starting a document imaging project.

•  The digitization process at FCBDD Service Coordination in 2010.

•  Benefits of digitization. •  Lessons learned.

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THINGS TO THINK ABOUT

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STARTING OUT

•  Assess your situation –  Possible reactions to your project. –  There is no one perfect solution for records

management. –  Analyze the unique needs of your agency and

departments. –  Understand the initial costs as well as the

support costs of your records management solution.

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ROADBLOCKS

•  Watch out for people who resist change. –  “We never use those records. Why should we

digitize them?” –  “It’s easier to keep paper copies at my desk.” –  “I don’t trust the computer/IT Department/

Technology in general.” –  “But we’ve always done it this way.”

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ROADBLOCKS

•  Conversely, watch out for people who are overly optimistic. –  “This is going to solve all our problems!” –  “If it’s on the computer, we don’t have to worry

about HIPAA in our building.” –  “This is just a one-time cost and then we don’t

have to pay for staff or space again.” –  “We’re going to be completely paperless when

this project is done, right?”

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MEDIA TYPES

•  This presentation focuses on digitization, but there are two other options. –  Microfilm –  Maintain paper copies

•  Regardless of the format, each type of media has associated costs and individualized pros and cons. –  These issues are driven by many factors,

including: records volume, access frequency, county resources, and storage.

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MICROFILM: It’s not just for 1970’s libraries •  Pros: •  Microfilm is stable.

–  Microfilm is useful for records that you need to keep beyond 20 years due to historical value.

•  It can be cheaper to film than to purge. –  Preservation vs. Access

•  Microfilm is eye-readable. –  Even though it’s cumbersome, you can view a

record even if the power is out. •  In a real catastrophe, you could even use a

flashlight and a broken coke bottle.

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MICROFILM: It’s not just for 1970’s libraries •  Cons: •  Microfilm does not lend itself to frequent

access by multiple users. •  Microfilm still requires physical storage

space for the film and the readers. •  Microfilm readers are getting rarer and

more expensive. •  Not easy to convert everyday digital

records to microfilm.

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MICROFILM: It’s not just for 1970’s libraries •  Costs: •  Preparation, indexing and conversion of

records to film. •  Different types of film.

–  Original silver microfilm. –  Diazo duplicate copies for normal retrieval.

•  Need to store originals and duplicate copies in environmentally-controlled areas.

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PAPER: If it ain’t broke… •  Pros: •  You probably already have most of your

documents in this format. –  This also means you already have the storage

system, the floor space, supplies and equipment, some sort of indexing system, and staff that are already filing.

•  No new systems to learn.

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PAPER: If it ain’t broke… •  Cons: •  There is a large footprint of office space

being used for cabinets. •  Everything is in a central area, creating a

bottleneck for users. •  Physical security risks.

–  Are all the cabinets locked down? –  How are SSAs taking records to meetings? Are

you sure they’re taking a copy and not the original?

–  What happens if the building catches on fire?

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PAPER: If it ain’t broke… •  Costs: •  Labor costs.

–  Includes: Filing, re-filing, searching for records, making photocopies, boxing up files for storage, etc…

•  Storage costs for any off-site records. •  Added supply costs of paper, copiers,

mailing costs, etc… •  Fines, lawsuits, and bad PR if your only

copy is lost or destroyed.

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DOCUMENT IMAGING

•  Pros: •  Can result in a much more streamlined

records department. –  Items less likely to be misfiled. –  Software helps keep indexing consistent.

•  Saves money on paper and mailing costs. •  Can free up a tremendous amount of

physical space. •  Increases response time to individuals.

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DOCUMENT IMAGING

•  Cons: •  Quick and easy access to files means its

easier to commit a HIPAA violation. –  “Oh I see his ETR in the system now, let me

just email it over.”

•  You might have to create a new indexing system.

•  Compliance standards with OHS, HIPAA, etc…

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DOCUMENT IMAGING

•  Costs: •  Preparation, indexing and digitization of

records. •  Document management system and

integration with existing software. •  Future migration of images to new

software or hardware. •  Retraining existing clerical staff or hiring

new staff. •  IT maintenance costs.

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ANALYZE YOUR RECORDS

•  What are our retention policies and schedules?

•  How many records do we have? •  How many people need access? How

frequently? Do they need access simultaneously?

•  Where are our users located? •  What formats are we using? (Word, email,

paper, etc…)

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ANALYZE YOUR RECORDS

•  How are we sending copies out of the office today?

•  Do we have to maintain certain records regardless of their age?

•  Do we have records that are continually updated? Do we have records that need to be kept in a specific state? (Case notes/ISPs/etc…)

•  Do we have a solid records retention and management procedure? –  Not sure? UPDATE IT.

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LET’S GO DIGITAL

•  We’ll assume you want to digitize your records.

•  What are the big picture questions we need to answer?

•  How are we going to prepare files? •  Do we need a records manager? •  Who needs to be involved in the project?

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BIG PICTURE QUESTIONS

•  At what point in the workflow will documents be scanned?

•  Are we going to scan everything we have? All new records starting tomorrow? A combination of both?

•  What’s our current indexing system? Are we going to have to update it?

•  How are we going to scan all these files? Internal? Vendor?

•  How are we going to do quality control?

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PREP WORK

•  Files need prep work. –  Most records need work to get rid of staples,

tape ripped pages, straighten wrinkled documents, make copies of damaged or odd-size documents.

–  Who is going to weed our records for duplicates and misfiled items?

•  Will it cost more to have staff weed records compared to storage space costs?

•  Will existing staff do prep work? Should we hire temps? If we use an outside vendor, is it cheaper for them to do it?

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WHO IS GOING TO DO THIS?

•  Do we need a records manager? –  Depends on the size of the collection or if you

plan on having someone responsible for the entire agency.

•  Who needs to be involved? –  Department heads, clerical staff, IT department,

fiscal, HIPAA officers.

•  Who is going to prep, index, and scan? –  Employees need to be invested in the end

result of the project. –  Motivated existing staff or skilled temps.

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HOW DO WE DO THIS?

•  Make a plan that considers all the previous factors. –  We’re going to scan all the paper documents as

they get routed to the records room. –  We’re going to have staff forward all electronic

records to a central records email. –  We’re going to scan all of our documents at

once and scan forward as we get new items. –  We’re going to have staff prep documents as

they index and scan.

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HOW DO WE DO THIS?

•  Make a plan that considers all the previous factors. –  We’re going to incorporate document

management software into our existing database program.

–  We’re going to slightly modify our existing filing system into an index.

–  We’re going to hire several skilled temps that will help get the bulk of our files scanned, then we’ll utilize existing staff in the future.

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HOW DO WE DO THIS?

•  Make a plan that considers all the previous factors. –  We’re going to have someone spot check all

scans. If a temp or clerical worker can get through several weeks without any mistakes, they can be trusted to scan and index with reasonable accuracy.

–  The IT department is going to help set up an audit trail on the servers so we can track access, deletion, edits, etc…

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FCBDD CASE STUDY

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IN THE BEGINNING…

•  When I was first hired in October 2009, we had about 150 five drawer cabinets full of consumer records. –  These cabinets, along with clerical work space,

took up about 3,000 square feet of office space.

•  We decided to weed our records as we scanned using audit periods established in our retention policy. –  We were able to reduce the amount of paper by

40% with just this step.

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IN THE BEGINNING…

•  Service Coordinators would need 24/7 access from multiple locations, so we decided on software with Gatekeeper integration. –  We also rolled out air cards so that Service

Coordinators would be able to access our network securely in the community.

•  We decided on a minimum 200 DPI G4 TIFF format for all of our scanned images. (Based off of Ohio Electronic Records Committee best practices)

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IN THE BEGINNING…

•  We hired twelve skilled temporary workers for a 6 month project. –  All but one had a Masters of Library and

Information Science degree. –  Created buy-in from the start with highly

educated/skilled temporary staff.

•  We contracted with a high volume scanning company to do prep work and scanning. –  Bid process revealed this was the cheapest

option. –  All records were available for review during the

scanning process. 29

IN THE BEGINNING…

•  We created a large taxonomy so we could assign a document category and type to each document. –  We numerically coded the taxonomy so that we

could index documents by hand and have the scanning vendor key in index fields as they were processing.

•  We worked with vendors to establish three other indexes to help uniquely identify each document.

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INDEXING AND SCANNING

•  Indexing –  Started off with 150 cabinets of files. –  Over six months, my staff and I indexed all

existing records. •  About 7000 active clients. •  About 350,000 documents. •  About 3 million pages.

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•  Indexes –  Consumer Name –  Document Category –  Document Date –  Document Type –  Resident ID

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•  We used bar coded sheets to index. –  Created cover sheets for all of our clients with

coded and eye-readable values for Consumer Name and Resident ID.

–  We used bar code sheets with a “BREAK” message and wrote numerical values for Document Category, Document Type, and Document Date.

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•  Ensuring quality control. –  First few weeks of the project involved group

indexing and a lot of questions/clarifications. •  Established indexing rules for irregular

documents. –  Indexers had to bring suspected duplicates to

the records manager for final inspection. •  If the indexer had a few weeks of correctly

identified duplicates, they were allowed to weed out duplicates without oversight.

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•  Ensuring quality control. –  Spot check indexed items before they were

sent off to be scanned. •  Verify correct index values for category, type,

and date. –  Spot check digitized items as they came back

from scanning to ensure that index values associated with TIFF file match index values on cover sheets.

–  After files were indexed and bundled for shipping, we limited SSA access.

•  Indexers pulled requested items, made copies, and replaced in the bundles.

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•  Breaking down files. –  Indexers broke down file folders and indexed

individual documents. –  Our vendor quoted us a low rate for staple

removal, so we left stapled documents intact. •  If several documents were stapled together, we

broke them apart so we could individually index the records.

–  Indexers made photocopies of fragile or hard-to-read items, then sent the copies to be scanned.

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DIGITIZATION

•  We bought two 1 TB external hard drives for less than $200.

•  We shipped one to our scanning vendor to upload test TIFFs, then they sent it back when they came to pick up new files. –  This repeated back and forth with both hard

drives until the project was over.

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DIGITIZATION

•  We worked out a spreadsheet format with our scanning vendor and our document imaging vendor. –  Each TIFF had a row on the spreadsheet that

gave the file path on the drive along with all five index values

–  We ended up with a Pipe Separated Value export instead of the standard Comma Separated Value because our “Consumer Name” index contained commas.

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DIGITIZATION

•  Our document imaging vendor had an executable that would import the TIFF files into our database with their corresponding index values. –  This was very sensitive and prone to long

strings of errors if there was an erroneous keystroke in the spreadsheet.

–  We invariably made a keystroke error and had import issues.

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DIGITIZATION

•  Once the physical indexing was winding down, our indexers began scanning and indexing loose files. –  We established ideal settings for our scanners,

became proficient with our software, discovered common errors, etc…

•  We also noticed common Quality Control issues. –  i.e. A document for Client A was in Client B’s

folder and was indexed for Client A. –  Easily correctable using our software.

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FINISHING UP

•  About 5 months in, we finished the physical indexing and started scanning new files that had accumulated during the main project. –  If something came in and we had already

processed that file, it was filed in a “New Files” cabinet. Otherwise it was just filed and indexed normally.

–  We had a lot of A-N overflow to deal with.

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FINISHING UP

•  As we went through the project, we gradually developed a more refined indexing scheme. –  We went back and corrected/clarified indexing

issues with the first few batches of files.

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COMMUNICATION

•  I sent out weekly updates throughout the project to stakeholders. –  IT Department, SSA Directors, our CFO, key

staff at Consumer Data Management, etc…

•  We were able to address issues in different departments and everyone was always aware of how the project was progressing.

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COMMUNICATION

•  As we neared the end of the project, we established groups within the SSA department to discuss issues. –  Revising our Records Retention/Management

policy. –  Updating confidentiality procedures. –  Digital Signatures.

•  We also had good communications between IT and our vendors to address issues as they arose.

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BENEFITS OF DIGITIZATION

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STREAMLINING

•  No more paper files in the office. –  Paper files are stored at a secure location. –  Files are no longer misplaced or misfiled due to

people making photocopies. –  Documents can be e-mailed or e-faxed from our

image viewing program. •  Saves paper. •  Faster than using the fax machine or printing a

document and mailing it.

•  Saves space. –  10% of our existing office space was previously

taken up by filing cabinets.

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STREAMLINING

•  Reduces filing errors. –  Our indexing system uses a controlled

vocabulary that helps to ensure we’re entering the correct information.

–  The system gives prompts and error messages if an index field is left incomplete.

–  Local ID and Resident ID numbers are automatically entered once an indexer selects a client, reducing the chance for incorrect data entry.

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STREAMLINING

•  Increases response time to clients and agencies. –  We can quickly access a client’s files through

our database without the need to sort through physical files.

–  Documents can be emailed as an encrypted PDF.

–  Instant turnaround to clients and their guardians.

–  If a signed release is provided, instant turnaround to doctors, providers, SSA disability determination, etc..

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STREAMLINING

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STREAMLINING

•  The average time it takes to process a disability determination request from OOD is two minutes. –  Find the individual in Gatekeeper and access

their digital file. –  Locate the current ISP and most recent medical

and psychological evaluations. –  Create a PDF and watermark it as

CONFIDENTIAL. –  Login to SSA Electronic Records Express, enter

the information from the release and submit the PDF.

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SUPERIOR CUSTOMER SERVICE

•  “This has been so helpful in moving the employment first process along! Honestly… it all starts there! Without him providing me the records to move consumers through the process, we would not have the first placement in the state!!!!” –  OOD/Employment First counselor assigned to

FCBDD

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TIFFS INSTEAD OF PAPER

•  Follows state and federal regulations on: –  Records Retention. –  Archiving.

•  Ensures integrity of original document. –  Stored as a high-DPI TIFF file on our servers. –  PDFs are created from the master copy.

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PORTABILITY

•  Document images are available 24/7 through Gatekeeper.

•  Service Coordinators are able to access Gatekeeper from almost anywhere in the field via air-card.

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LESSONS LEARNED

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MEASURE TWICE…

•  Be sure to plan everything as much as you can before starting the project. –  It’s much easier to change something before it’s

associated with files on a server. –  Don’t decide to make a big change once you’ve

already spent time and money on vendors.

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PILOT YOUR PROJECT

•  Our pilot project wasn’t exhaustive enough and we ran into preventable problems. –  There were some irregular documents that we

should have identified and planned for in the pilot.

–  Our taxonomy could have been adapted before production.

•  Instead, we spent extra time and energy fixing mistakes during quality control.

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TEST DATA MIGRATION

•  Be sure to run multiple test migrations of data to ensure your import process is working correctly. –  This will help eliminate the chance of bad data

or orphaned TIFF files. –  Try to make the process as automated as

possible. Manual data entry will eventually produce a typo.

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TEST DATA MIGRATION

•  We had a few successful batches before a keystroke error resulted in a few hundred individuals’ files being imported improperly. –  All five index values were attached to a TIFF

that didn’t exist on the server. –  We couldn’t delete them using the document

imaging software. •  The system wasn’t coded to delete a TIFF file

that didn’t exist. –  We had to fix the ghost files using SQL scripts

on the server.

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CHEAT SHEETS

•  It’s a good idea to firmly establish your indexing procedures on a cheat sheet available to all indexers.

•  I initially answered indexing questions on a case by case basis. –  This lead to one type of document being

indexed differently by different staff. –  Fixing this later in quality control took more time

than properly informing staff during the project.

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CHEAT SHEETS

•  A cheat sheet is effective when dealing with irregular documents. –  Everyone should know how to process an ISP,

but what about a written letter from an occupational therapist asking that IO Waiver funds be used to purchase a piece of equipment?

•  Is it an OT Evaluation? A letter? Waiver correspondence? A prescription?

–  Whatever you decide, codify the decision and follow it.

–  If you’re going to be wrong, at least be consistently wrong so you can batch edit later.

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BE SURE ABOUT YOUR VENDORS

•  We picked a vendor whose document imaging software was integrated with our consumer database software. –  Unfortunately the contract between the two

vendors fell apart as we began our indexing. –  The expected level of cooperation wasn’t

present.

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•  Initially, we expected the image viewer software to be integrated by consumer. –  An SSA would find their individual in our

database, click on a link, and be taken to the images associated with that DODD #.

•  This would have allowed us to set search parameters, run them against the database, and retrieve only the records we needed.

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•  Right before we went live, our document imaging vendor made a change that essentially broke the level of integration we were expecting.

•  Instead of being able to identify an individual and search for only their records, we had to first load the entire database, then narrow it down with search strings.

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•  SSAs had to wait 5-10 minutes for a massive table to populate, then use a text-based search to find a person on their caseload. –  This was a massive hit to staff buy-in. –  Manually keying in search strings lead to a lot

of errors and frustration. –  Opened us to confidentiality issues. –  The load times got worse every day as we went

from 350k to 550k documents before we switched vendors.

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TYPICAL EMPLOYEE RESPONSE

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#%&!


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•  Obviously certain things will be out of your control, but it’s best not to aggravate the end users right out of the gate.

•  Ask detailed questions about support, integration, etc… early on in the project.

TRAINING

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•  One of the questions you should ask a vendor is “Who is going to train our users?” –  Will the vendor have someone train all your

staff? –  Is it going to be a ‘train the trainer’ situation? –  Are you all on your own?

TRAINING

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•  Just like everything else, try to pilot your training with staff.

•  Be sure to include a broad spectrum of employees. –  Nice people will say that you did a good job.

Not so nice people will say things that actually help you improve your training regimen.

TRAINING

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•  Create a pretend individual in your database with fake images. –  We initially used actual consumers during the

hands-on portion of our training. •  Probably not the best idea with respect to

HIPAA.

•  Remember to explain things that seem obvious to you. –  I had tons of people ask how to move between

pages, even though we had basic arrows on the toolbar.

TRAINING

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•  Create a quiz based on FAQs that staff can take with them after training. –  This can be a quick reference tool for them at

their desk.

THE END

•  Questions or comments? Jonathan Zuhosky Service Coordination Records Manager, MLIS Franklin County Board of Developmental Disabilities p. 614-342-5431 [email protected]

Thank You!

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