Frontlines of Document Scanning: Insider Describes Duties, Complexities of Helping Medical Practice Go Paperless

Guest post provided by Keli S. a Scanner Operator with OptiScan.

I am a scanner, and I really enjoy my job. Now don’t get me wrong – there are parts of it that can be tedious and boring – but I’ve never had a job or even a hobby for that matter that wasn’t tedious and boring at some point.

Lately, I have been scanning charts for a cardiology practice, and I thought I’d share some of my thoughts with you. This is a rather large practice. It has several locations in Tucson, a few satellite offices in the surrounding areas and an office in Nogales. We are scanning all of the charts into NextGen EMR. Sounds like a royal mess doesn’t it?

Not so much. Here’s how we make it look easy:

Advanced Preparation is Key for Scanning Medical Charts

Normally, doctor appointments are made in advance (barring emergencies). So before we start scanning, the medical staff pulls all the charts needed for a week’s worth of appointments.

This makes the scanning process much easier, as any charts that aren’t scheduled remain on the shelves. The medical records department pulls those charts in alphabetical order, sticks 20 or so in a box, and then sends them to the preparation staff. The prep staff will pull the requested information from the charts and place the now loose papers (with their NextGen generated cover sheets and tab sheets) back into the box with the empty folders and give them to me. We call this a batch.

Each batch is numbered, and kept in alphabetical order. Since this practice has multiple locations, we can’t simply use a straight numeric format. The first letter of each office’s name is used with a three number string. For example, the Northwest office was N001 and up. (It actually had over 500 batches… now that I think of it… all of the locations I’ve scanned thus far have had more than 500 batches.)

Inside the Chart Scanning Process

Once I have the batch, I go through the massive pile of papers to double check for bent corners, staples, Post-It notes and half sheets of paper – all of which will cause imperfect images. The preparation staff look for and fix the aforementioned issues too, but I like to double check. Afterward, I break the massive pile of papers (often ranging from 600 to 1,800 individual sheets) into a pile the scanning machine can handle.

I am currently using an industrial Panasonic scanner that can accept a pile of some 300 pages in the tray.. Once I’ve reviewed all the batches, I can generally scan a batch in 20 minutes. An average-size batch is about 1,200 to 1,300 pages with approximately 18 to 22 charts in it. In most cases, charts are returned to the shelves within a day or two.

All and all, a simple and relatively painless process right? Oh wait, I said “barring emergency” appointments.

Expecting the Unexpected: Chart Availability During Emergency Appointments

Unfortunately, we can’t all plan our doctor appointments with two weeks notice. So what happens if there is an emergency? What do you do when a needed chart is mixed up in the scanning process? You ask for it. When will I get the chart?

That depends on two things:
1) when you need the chart and 2) where the chart is in the scanning process.

If the answer to “when do you need it” is now, then no matter where in the process it is, we will find it and get it back to you. If the answer is in 20 minutes, then the chart will be found – and no matter what stage it is at – it will be hurried through the process.

What if I can’t find a chart and I think I gave it to you for scanning… but I don’t know when or even if I gave it to you? If we can’t find it in one of the batches, then we obtain enter the medical records number into the internal web application called the OptiScan Chart Finder. This OptiScan application allows us to search the database of all scanned charts.. It will tell us if the chart has been scanned and what batch it’s located in (and now you know why we number them).

The batch number allows us to search for a specific box, and tells us when that box was scanned. We keep a number of records to let us know when and who did a specific batch. The preparation staff keeps a spreadsheet listing of who prepped a batch number and who put back that batch number.

I keep like to keep a separate spreadsheet in which I record what day a batch is given to me, who prepped it, who scanned it, when it was scanned, how many charts were scanned and how many pages was in each batch.

I hope this give you a little more insight into chart scanning process. I encourage you to learn more:
• Scanning Options for Patient Charts
• Producing Quality Scanned Images
• Medical Chart Processing Appliance

Scanning Options for Patient Charts

Once a medical practice has implemented an Electronic Medical Record system or Practice Management system it becomes very easy to manage new patients. The new challenge is how to efficiently and cost-effectively migrate important paper chart information into this new system.

The fastest way is to use a scanning services company to setup on-site, image, link to patient database, and import into the implemented EMR system. The Optiscan ChartWorx system has been created for this purpose. This option is also cost-effective when considering projected paper chart handling and storage. Check out our presentation for more details.

Regards,
Michael Hawkins
Business Development
Optiscan Inc.
http://www.optiscan.net
B: 602-789-7800
C: 602-882-3364

Producing Quality Scanned Images

Concerned about the quality of the documents that you need scanned? There are a number of ways to enhance the quality of scanned documents, providing a document that is easier to read and readily printable. A professional scanning company focused on quality, such as OptiScan®, will use these methods to generate the best possible scans from your documents

Images can be improved in a number of ways. Simple changes such as thickening existing characters using sophisticated processing utilities are easy ways to optimize the image storage size and make the document more readable. More complicated techniques such as multi-streaming, where both the black and grayscale images are produced at scan time will ensure the client gets the best possible image. During the quality control process the quality control professional can review both images and insert the one the one that provides the clearest images. Although the black and white scan is usually sufficient and captures all readable information, there are times when the grayscale image is necessary to capture very light print.

Scanning, along with image processing, provides many more advantages than simply having digital files available. It also provides an opportunity to improve the readability and usability of the documents. The experience of a professional scanning company, such as OptiScan, can help you get the most from your files.

Michael S. Hawkins
OptiScan Inc.
Business Development
http://www.optiscan.net
Cell: 602-882-3364
Work: 602-789-7800

Want additional information?
Follow us on Twitter at twitter.com/optiscan!

Medical Chart Processing Appliance

The system that scanning companies use is an integral part of the overall scanning process. Systems, such as the OptiScan® ChartWorx appliance, are able to integrate with existing practice databases providing a valuable tool for associating the scanned images with chart data.

Such systems can provide specialized intranet web applications to determine key project statistics, provide patient scan status reports, and can generate cover sheets for scanning patient charts. This reporting interface provides real-time statistical feedback to both the scanning company and practice management. Progress can be monitored daily, providing a valuable tool in determining estimated project duration as well as scanning and preparation personnel efficiency data.

The scanning service provider must provide the most suitable scanner and image processing software for a successful outcome. Be sure that the company that you choose has the systems in place to meet your needs and deliver the data the way you need it.

Michael S. Hawkins
OptiScan Inc.
Business Development
http://www.optiscan.net
Cell: 602-882-3364
Work: 602-789-7800

Want additional information?
Join us on Twitter at twitter.com/optiscan

Should We Scan Everything?

Over time, companies can become bogged down with paper archives. It is not uncommon to find that some of the paper found in these archives is irrelevant to the business. One of the most important decisions when transitioning to a digital record system is deciding what to scan. Initial digital record system implementation provides a perfect opportunity to digitize and simplify these files. Digital record management companies, such as OptiScan®, can use their years of experience and highly trained professionals to help you determine the best approach for your company.

Some businesses elect to scan their entire archive. This is the easiest and fastest approach, but it can also be the most expensive as most jobs are priced based on the overall scanned page count of the project. However it is the most efficient, as it allows for files to be prepped in a standard manner (e.g. insertion of barcode sheets, removal of staples and paper clips, taping down of smaller sheets which can jam the scanner) without sorting through the paper content.

Other businesses will elect to scan designated sections and data from each file. This approach requires more time, as the preparation process is more time intensive. Preparation of the files requires a more detailed review of the files to ensure that the correct data gets scanned. This will increase preparation time of each file and increase the overall timeline of the project.

There are both advantages and disadvantages to scanning designated portions of the files. One of the advantages is that with the elimination of useless pages, the files become smaller and easier to manage. The relevant data becomes easier for office staff to locate, requiring less search and retrieval time. Smaller files also take up less computer storage, allowing data to be stored in smaller servers. However, there are also several disadvantages to this approach. The first is the accuracy of the sorting. While scanning companies employ trained professionals to complete the assigned tasks, they are not professionals in your business and mistakes related to business content can be made when prepping the files. Another disadvantage is the increased preparation time which can extend your project scanning timeline.

The decision to scan an entire file versus a partial file should be carefully considered. While it may appear that eliminating the useless pages would lead to less overall pages being scanned, thus lowering your cost, this if often not the case. In most cases the cost is simply shifted from the scanning to preparation portion of the job. On the other hand, eliminating the useless pages during the scanning process will ultimately lead to smaller, more concise files. The pros and cons should be carefully considered when deciding what to scan.

Michael S. Hawkins
OptiScan Inc.
Business Development
http://www.optiscan.net
Cell: 602-882-3364
Work: 602-789-7800

Want additional information?
Join us on Twitter at twitter.com/optiscan

File Scanning Evaluation Process

When starting a new scanning project, it is important to thoroughly understand the needs and expectations of the business. Each new project comes with its own set of challenges and requirements and it is essential to have a complete understanding of these before starting the work. That is why the first thing that many scanning companies, such as OptiScan®, do is set up a meeting to actively discuss the project scope with the business.

The first part of the evaluation process is to clearly define the overall scope of the job. How many files will be a part of the project? Is the scanning company staffing the entire project or will there be assistance from the office staff? How much office space is available for the overall project? Are there any special requirements of the office? What is the expected timeframe for project completion?

Using this information, the scanning company will be able to determine the best equipment to use, the number of personnel required and what special challenges this project will bring. Limited workspace is one of the more common challenges that scanning companies face when starting a new job.

During this meeting it is also important to clearly identify the processing rules of the pages being scanned. For example, OptiScan must determine how and what index data must be associated with the documents so they can be easily searched in the new database. If a business has an existing database of records with unique reference numbers associated with them, a barcode cover sheet can be used to associate index data with the scanned documents. If this is not possible, often Optical Character Recognition (OCR) software can be used to automatically read the index data from the relevant pages. As a last resort, if data is difficult to read, handwritten, or located in different areas of the page, the index data may have to be keyed-from-image. With the many years of experience in processing millions of pages for a variety of different industries, companies such as OptiScan can provide the most valuable and cost-effective processing methods.

Once the job and expectations have been clearly defined, it is possible to determine the right pricing structure and timeline for the project. It is the goal of OptiScan, like many scanning companies, to provide the practice with the best quality images and service within the agreed upon timeframe and at a fair price.

Michael S. Hawkins
OptiScan Inc.
Business Development
http://www.optiscan.net
Cell: 602-882-3364
Work: 602-789-7800

The Scanning Process

Preparing the Files to be Scanned

The most important and time-consuming part of the scanning process is prepping the paper files for scanning. Before files can be scanned, all staples and paper clips must be removed and all Post-it notes must be taped into position to ensure that they can pass through the scanner without jamming it. It is important that all messages and notes containing information are attached to a page in a way that it can easily be referenced in the new digital format. Another important step during the file preparation is the insertion of bar coded cover sheets. These sheets identify document index data, as well as provide section or document break information.

Preparing the files takes time and care. Skilled and experienced professionals, like the staff from OptiScan®, can process thousands of sheets per hour and take the strain off of an already busy office staff, allowing them to focus on what they do best.

The Scanning Process

First, let’s take a moment to talk about scanners. Not all scanners are created equal and it is important that your Scanning Service works with your company to select equipment appropriate for your needs. Scanners come in different shapes, sizes and speeds – and are generally priced accordingly. The average page rates for medium to high level scanners range from 60-100 pages per minute. Scanning companies, such as OptiScan, will use their experience and assess each clients needs individually and select equipment based on these needs.

Once the equipment has been chosen and the files have been prepped it is time to scan the data. As the pages are scanned they are imported directly into a software system, where the barcodes are read and key index data is retrieved and entered into the database.

After the Scan – Quality Control

Once the scanning is complete, the work is far from over. The newly scanned data enters into the quality control phase, where data is carefully reviewed by experienced professionals to ensure that it meets the company’s quality standards. These professionals enhance the scanned images to improve readability and orientation, as well as delete irrelevant scans. The next step of the quality control phase is the index validation. During this phase, the quality control professionals will validate the barcode index data and section break location. Additional index information can be efficiently keyed in or merged with external databases, if required. Once this step is complete, the documents are ready to be exported to PDF’s and delivered according to the clients’ requirements.

As you can see, there are many steps involved in transitioning from paper to digital records. With the importance of the records to your business it is essential to understand the entire process and the value that a Scanning Services company, such as OptiScan, brings to it.

Michael S. Hawkins
OptiScan Inc.
Business Development
http://www.optiscan.net
Cell: 602-882-3364
Work: 602-789-7800