Sunday, June 18, 2006

Handling scanned documents

Last week was very good. Everything worked, and I even entered all the CPPs ahead of time for two days. I was completely paperless those days, which gave me a taste of what my office will be like in three to four months. I like it.

I got a call from someone who works in technical services at SSHA. He said that the inconsistent speed was because the wiring in my area is very old; we have copper wires. They are working with Bell to try to improve this, and may be able to give me some work-arounds.

A colleague was asking me about how scanned documents are handled in the EMR, so I will give a brief overview here. There are two types of scanned documents:
  1. the old chart
  2. new incoming documents (Diagnostic imaging reports, consult letters etc)
1. It is not useful to have the old chart scanned as part of the EMR. You would have to classify each piece of it (is this report filed as DI? Is this a consult letter? etc) which is very time consuming. What we will be doing over the summer is scanning each old chart as a single pdf document (the scanner does 25 pages per minute, or 50 pages if you scan both front and back). Each scanned chart will get a file name (last name, first name). Those charts will be then be saved to an external hard drive, which will be attached to one of my computers and shared across the network. If security is a concern, you can assign a password to the files. I will also back up the whole thing to a DVD, which will be kept offsite.

You can load the pdf file from the network if you need to look at the old chart; also, pdf files are searchable.

For files of deceased/transferred patients, there is no need to keep them on the network, because I will not need to look at them. They will be put on a DVD (locked away at the office), with a copy on a second DVD, kept offsite. DVDs cost about $1 each.

I have hired a student to do my scanning this summer. The reason to scan the old charts is that then the paper is gone forever from your office, and the cost of ongoing storage is zero; also, with a back-up to DVD, you can never lose your charts to an office fire.

2. All new incoming paper/fax documents are scanned to the EMR. They can be classified in the chart as DI, consult notes, lab, ER notes etc. My filing clerk does this when she scans and uploads documents. She also adds extra information, such as the name of the specialist, or the type of DI. When I look at the file, I may put in a comment, for example "XR normal". Then I have a good overall summary of all DIs for this patient in a single area of the chart.

Loading the scanned document so you can look at it takes time; I try to put the useful information in my comments area so I don't need to bring up the whole document. This is usually very brief (example, for a derm consult: Dx acne rosacea, Rx metrogel). If I need to copy a bigger piece of the report for the comments, then I use OCR (optical character recognition). There are various ways to do OCR; what I do is send the scanned report to Microsoft Document Imaging (file, print, MS Document Imaging), then I hit the OCR button, then copy and paste to comments.

I also had to decide what to do with various pieces of paper that can't be efficiently scanned to the EMR, for example, ongoing allergy shot records, or 2 step TB tests (4 visits) for hospital volunteers. The allergy records are now kept in the box with the allergy serum, and not with the chart. I will scan that in when the allergy series for that year is completed. For the 2 step TB, I give the form back to the patient; it is their responsibility to bring it back each time they come in. We scan the report when it is completely filled in.


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