Introduction to Scanning

Scanning is the process of "digitizing" a paper document so that it can be stored in a computer. This process can be utilized in a clinical setting to help insure that incoming paper documentation is included within the patients’ chart. It is one of the essential steps in making the full transition from paper to electronic records. Scanning allows Practice Partner Patient Records users to upload paper documents and place them into the correct place within the correct patient chart.

The Benefits of Scanning
Scanning provides an efficient way of loading printed documents into. Once the information is in the electronic patient chart, the data contained in the scanned document is accessible to all authorized users, eliminating the need for paper documents to be pulled and filed. Scanning paper documents is another step in the process of creating a "paperless office," and is something that every practice that wants to take full advantage of their EMR should do.

What Kind of Documents Need to be Scanned?
Any paper documents or correspondences that would be a useful addition to a patient’s chart should be scanned into the electronic chart. These include letters, discharge summaries, ECGs, and laboratory data. By scanning these and other important paper documents, they become accessible to both provider and staff.

How Scanning Works
Scanning allows the computer to "take a picture" of paper documents. These pictures can be of images (such as photographs or ECGs), of text (such as letters), or can incorporate both. The initial scanning process is the same for both graphics and text – as they are initially scanned and a picture of the original document is created in the computer. With images, such as an ECG, the image can then be loaded into Patient Records . But with text, another step is involved requiring the use of Optical Character Recognition (OCR) software. OCR software takes the text found in the scanned picture and converts it into formatted text. The main advantage this has is that formatted text requires much less disk space than images, and with, the formatted text becomes searchable, where an image of text is not searchable.

How Do I Begin the Process of Scanning?
The first step in the process of scanning is setting up a scanning workstation. A scanning workstation is a computer coupled with a scanner. This PC can be utilized for other clinic operations, but must be available for scanning when needed. It is preferred that the scanning PC is connected to the network and running. (Minimum requirements for a stand-alone scanning PC: Pentium 133MHz with 8Mb RAM, CD-ROM recommended for installation of scanning software).

Once a PC has been designated the scanning PC, the appropriate equipment needed to be purchased:

Hardware required:

• TWAIN-compliant scanner* (recommend HHP ScanJet 5100 or 6200, or UMAX Astra 1200S)
• Paper shredder with continuous motor (recommend GBC Shredmaster 1026S) to destroy your scanned documents.

*TWAIN is a software interface that eliminates the necessity to leave the software application you are working in to scan an image. With TWAIN you can scan directly into whatever program you are using at the time.

Software required:

• Windows 95/98
Practice Partner Patient Records
• Professional quality OCR software* (recommend Caere OmniPage v8.0) Note: scanners usually come with OCR software
• Text Editor (Notepad or Wordpad) or TextCoder for Windows (recommended)

*Optical Character Recognition (OCR) software reads the text of the "picture" from the scanner into a text that that can be loaded.

Incorporating Scanning into the Clinic’s Workflow
Once you have setup your scanning station, the workflow for scanning needs to be established. The typical workflow incorporating scanning involves physicians quickly reviewing incoming reports daily and initiating any necessary action. Once reviewed, the reports are placed in a "to be scanned" file. The scanning workflow for graphic and text documents varies slightly. For image documents, the document needs only to be scanned before it is loaded into Patient Records , but for text-based documents, the reports must be OCR’s and edited, including the addition of dot codes (both done automatically by TextCoder), after they are scanned. The scanned text reports are then loaded into Patient Records via Text Data Loader. Once loaded, physicians can sign the reports electronically. Once the reports are saved, the original paper documents can be shredded.

This is just an example of a typical workflow involving scanning. Each individual clinic should incorporate scanning into their workflow in the manner they see fit. Reports can be scanned on a daily basis, or they can be grouped together and scanned on a weekly basis.

Scanning Images
Once an image is scanned, it is ready to be imported into Patient Records . As you work in any text-based section of the Patient Chart (e.g., progress notes, EKG's), you can attach an imported scanned image to the text. Once you attach the imported image and save it, you can view it whenever you are looking at the text. Patient Records supports both.pcx and.bmp image files.

Scanning Text
It is important to run your scanned text documents through your OCR software. This takes the text found in the scanned picture and converts it into formatted text. Formatted text takes less space to save than an image, and also allows Patient Records to be able to search the content of the document.

The first few times you run OCR, you should set the OCR preference to "Immediate OCR." This will allow you to review each scanned report immediately after it has been OCR’d. Although the OCR software will automatically choose the best setting for the original document’s font, it is best to check and make sure the scanned copy is legible. Once you are satisfied with the results, change the setting to "Defer OCR." This involves scanning all of your documents and then batch running them through the OCR software.

Reformatting Scanned Text Documents
Once a text document has been scanned and OCR’d, it needs to be formatted for insertion into Patient Records . The patient’s name and account number must be added to the report, guaranteeing that it will be inserted into the correct patient’s chart. Any artificial characters created during the scanning process must be manually removed, along with any blank lines.

TextCoder provides an improvement over text editors. With a normal text editor (such as Notepad or Wordpad), all of the editing of the scanned document must be done manually, but with TextCoder, the editing is done automatically. TextCoder reformats scanned documents to optimize their appearance in Patient Records . It does this by automatically:

• Removing artifact character created by the OCR software
• Removing blank lines
• Justifying the text to the left margin
• Formatting the font to 80 character lines
• Adding dot Patient Records codes

Setting up TextCoder
Before TextCoder can automatically reformat and deliver scanned images into patient charts, TextCoder needs to be customized to recognize clinic-specific names and procedures. The first step in setting up TextCoder involves copying over the doctors’ names and initials, patient names, chart sections, procedure list, and report titles (optional).

The final set in setting up TextCoder is setting your preferences. This setting allows you to run reports manually, or automatically as part of a group of reports. You can also set TextCoder to remove blank lines, remove characters generated by the OCR software (such as ~’^|), and save a copy of the original file. Once this setup is complete, TextCoder is ready to be run.

Running TextCoder
To tun TextCoder, the scanned documents file needs only be copied into the TextCoder directory, and TextCoder is ready to run. To code each report, the Patient’s name, Report destination, and Doctor’s name need to be selected from the drop down list created during TextCoder setup. Once these variables are selected, TextCoder will automatically reformat and insert the appropriate dot codes into the scanned document.

Inserting the Scanned and Coded Documents into Patient Records
Once the reports are reformatted and coded, just copy the new updated file containing the reformatted and coded documents into the Patient Records directory (ppart). Once copied, run Text Data Loader from Patient Records, and the reports will be loaded into patient Records, with the correct reports landing in the correct patient chart, updating the appropriate chart section.

Benefits of Utilizing TextCoder
TextCoder presents some obvious advantages to scanning workflow. Not only is there an improvement in productivity, but due to the ease of use staff satisfaction and morale regarding scanning is greatly improved. TextCoder also makes the information in paper document accessible from the patient chart in a more timely manner, providing physicians and staff with the information they need to better help their patients.

Comparison of TextCoder versus a Text Editor in Reformatting Scanned Documents