Doctors Offices Streamline IT Operations

Midsota Plastic Surgeons P.A. has been made over-IT-style.

Midsota Plastic Surgeons P.A. has been made over—IT-style. As recently as 1997, the St. Cloud, Minn., plastic surgery practice didnt even have e-mail. Now, MidSota is not only using Microsoft Corp.s Exchange and Outlook but is also using a document management system to expedite day-to-day operations, improve patient care and meet HIPAA (Health Insurance Portability and Accountability Act) mandates.

"When I came here seven years ago, the administrator needed something from me. I said, Why dont I just e-mail it to you? and he said, We dont have e-mail," said Chris Harbaugh, who holds the interesting dual role of occupational therapist and IT manager at MidSota. Harbaugh, a hand therapist licensed and registered in Minnesota, was hired at MidSota as a clinician. His computer savvy, however, quickly launched him into the position he now holds.

Harbaugh was instrumental in evolving the practices computing infrastructure from "piecemeal" to tightly integrated. "Originally, we had a very small Unix-based system, with about 20 dumb terminals throughout the organization," said Harbaugh. "After a while, we realized that, as our practice grew bigger, we needed to change."

The clinic is now using Windows XP workstations and servers running Windows Server 2003.

MidSotas computing evolution didnt stop at an updated infrastructure, however. A push to go paperless—and to streamline its operations and improve patient care—led to the implementation of Interwoven Inc.s WorkSite collaborative document management system.

Before using WorkSite, MidSota relied heavily on hard-copy records. Patient data was stored electronically, but it was passed around in paper form—often after a request for documentation had been broadcast over the public address system.

This process was prone to delays and distracting, said Harbaugh. "Being in a big clinic, one patient chart is [often] in a different department, and we started getting more and more paging overhead—Chart so and so needed here," he said.

Harbaugh and other clinicians at MidSota determined that they needed to create efficiencies and bring the clinics patient information in line with HIPAA mandates. They migrated all client records and clinic information to Interwovens WorkSite system, eliminating the delays associated with paper records and adding a higher level of privacy and security to patient data.

"[Before WorkSite] it could take days before a piece of paper got to a chart," said Harbaugh. "We still have charts, but if I need a surgical report on somebody, I go to my computer and its there within 24 hours. ... Also, permissions can be set down to the individual document, and we limit employees only to the documents they need to do their jobs."

MidSota bought the Interwoven software at the end of 2003, said Harbaugh. Interwoven officials said an organization with fewer than 100 users can expect to pay between $70,000 and $150,000 for WorkSite, depending on options and organizational needs.

Once the software was in-house, Harbaugh worked with representatives from different departments at the clinic to determine how the repository would work. He developed document classes and subclasses not only for medical records but also for such information as human resources documents. Stratika Professional Services Group, the Interwoven systems integrator that worked with MidSota, provided training and did the actual implementation.

It took about five months to get the Interwoven system up and running, said Harbaugh; WorkSite went live in July 2004.

WorkSites full-text indexing capabilities are particularly valuable to Harbaugh. "Before, we used a Windows folder system, and we could search only on patient number," he said. "Now, I can search for a specific name, date of birth, account number or word in a document."

Harbaugh has opted to run WorkSites full-text indexing on a dedicated workstation so servers wont be overloaded.

Harbaugh said one of the biggest benefits to the WorkSite system is that it lets him provide postoperative care more efficiently for his patients:"Its been nice to be able to look up a surgery report before I see the patient. In the past the patient would sit and wait."

Executive Editor Debra Donston can be reached at


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