FROM SCANNING to the Electronic Record at Skyline Family Practice
Paper documents come into the practice they are reviewed acted upon by the physician (the nurses and front office staff may help) and then forwarded to the document manager for disposition in the following order:
Please refer to the OMNIPAGE documentation for how to use OMNIPAGE to scan the documents. Remember to turn on the scanner before opening OMNIPAGE. See some of hints below regarding scanning.
Using Textcoder for Windows
Textcoder for Windows is designed to rapidly code scanned medical reports so they can be loaded into PRACTICE PARTNER (TM) Patient Records.
Features
Overview
Textcoder for Windows reformats scanned and OCR'd documents and inserts PATIENT RECORDS compatible dot codes to facilitate loading reports into PATIENT RECORDS. The following dot codes are used:
Code Description Function
.D: Date, Patient Name, and Account # Loads report to proper patient chart
.K: Chart Section Name Loads report to proper chart section
.T: Note Title (Report Type) Assigns report title (for searching)
.PV: Provider ID Assigns report to provider for signature
.PR: Procedure List (optional) Adds user-selected reports to procedure list
Set-up (note: this may already have been done)
Setting up Textcoder for Windows involves the following steps:
A) Doctor file
Normally, you shouldn't have to maintain this file since it is already set-up for use.
1) Open the Doctor.txt file with a text editor such as Windows Notepad or DOS EDIT. To use Notepad, find the file in the C:/txtcoder directory in File Manager and double click on it.
2) Enter each doctor name and initials on a separate line in alphabetical order by last name. Multiple doctors may be grouped together to allow multiple electronic signatures (separate initials with colons).
Examples: "All Doctors","FB3 : JHS"
"Bradd III, Floyd", "FB3"
"Smith, John H.", "JHS"
The initials must be identical to the provider initials used in PRACTICE PARTNER (in Set-up section of Patient Records - Provider set-up). Quotation marks must separately enclose the doctor name and initials, and they must be separated by a comma.
3) Delete the sample doctors, then save the file.
B) Test file
Again, this file is usually already formatted to work with the textcoder.
1) Edit the file test.txt in the same manner.
2) If you want the report title (".T:" line) at the top of the report, enter the report title, a comma, the name of the PRACTICE PARTNER chart section that the test should be filed in, then another comma. Examples:
CXR , X-ray ,
Cardiac cath , Special Studies ,
3) If you do not want a report title*, then only enter the PRACTICE PARTNER chart section name (in the first position) and two trailing commas. Example:
Consults , ,
(*It is important to use a REPORT TITLE - since we can tract specific report titles)
4) If you would like certain procedures to be added automatically to the patient's Procedure List, enter the procedure name again after the second comma. Example:
Colonoscopy, Special Studies ,Colonoscopy
5) IMPORTANT: Each entry must have 2 commas even if one or more fields are left blank. PRACTICE PARTNER chart section names must be spelled exactly the way they are set up in PRACTICE PARTNER (including custom chart sections). Commas should be avoided both in the test name and in the PRACTICE PARTNER chart section name. If it is necessary to use a comma in a name, then enclose the name in quotes. Example:
"Angiogram, cerebral", Special Studies ,
The PRACTICE PARTNER chart section for each test should reflect your preferences for where tests should be filed in the PRACTICE PARTNER chart.
C) Update Patient List
Important: This must be done regularly since the Patient List is used to place the .D code for each particular patient. It is suggested that this be done at least twice weekly.
The Patient List is generated by PRACTICE PARTNER and used by Textcoder to provide a look-up table of patient names and account numbers. The same procedure is used both to initially set up Textcoder and to periodically update your patient list.
D) Setting preferences (Note: this has already be done but read on)
You are now ready to use Textcoder to code your scanned reports.
Scanning Reports
Text scanning is usually performed through an OCR program - we use OMNIPage. All OCR programs work with TWAIN compliant scanners. When you launch your OCR program, you should review and change the settings based on the document your scanning. Usually, the only settings that need to be changed for certain reports are Character type Small text, and, rarely, Brightness setting. It helps to group all of your dot matrix printed reports, colored paper reports, and small text reports separately to be scanned in batches to minimize the number of settings changes. You may want to experiment with your OCR program's settings to find the settings that work best with certain types of reports. We currently use OMNIPage for our OCR scanning and save files in the *.txt (DOS text format).
Scanning - Most reports contain useless identifying information that clutters the report. This includes letterhead, internal ID numbers, addresses, and standard disclaimers. Since this information is usually in a header, footer, or side margin, you can fold it out of the way before placing it in the scanner (you can't do this if you are using a document feeder). The only identifying information you need to retain is the patient name, date, and report author ,address, and phone numbers. Review the quality of the OCR'd reports as you scan them. You can edit out text errors from within the OMNIPage program after each batch of reports is scanned, or later while running Textcoder for Windows. Textcoder will remove blank lines, re-format the text and remove artifact characters later, so do not edit those errors now. Also if you plan to use Textcoder in Automatic mode, type your marker text "sss" (or whatever marker you choose to use) on a separate line at the beginning of the first page of each report. Textcoder will use this marker to find each report, thus saving you time. Keep the reports in order as you scan them. You will need to refer to them when you run Textcoder.
5) Saving - Since scanning and OCR processing are very "processor intensive" and program crashes can occur, it is a good idea to save your work after every 20-25 reports.
Note: when you are ready to scan more documents (after loading the present batch), you will need to delete the present scanned documents. Otherwise any scanned documents will be added to the ones already done. In order to delete these follow the next steps:
Running Textcoder
The procedure for running Textcoder differs slightly if you selected Find Reports Manually in the "Preferences" screen. These differences are discussed at the end of this section under "Manual Mode".
A) Copy or move the text file to be coded into the c:\txtcoder\in directory (you may have
already done this in the above steps)
B) Start Textcoder - Select File, Run Textcoder
C) You'll be asked to pick the text file that at created above (i.e. 050998.txt)
D) Loading a report
E) Coding a report
To code a report, select the Patient name, Report type, and Doctor name from the drop
down lists. To fill the Patient name list box, TAB to the box (or click on it), type the first
three letters of the patient's last name, and press ENTER (it is important that you press
ENTER after you've typed in the patient's name so the program can go to the appropriate
place in the patient list). 2500 alphabetized names will load in the list box starting with
the first match to your entry. The proper patient can now be located by one of three
methods:
F) Now select the Report type in the same manner. You can click on the list box or press TAB to move between boxes. Again, use the ALT-arrow combination to open the box. If this box already displays the proper information, you do not need to select it. If the Report type is not in the list box, you may enter it manually into the Report type field. Use this format:
Report name, Chart section name
This is a temporary solution to a missing Report type. After your Textcoder session, you should edit the test.txt file to add the Report type (see Set-up Test file above).
F) TAB to or click on the Physician list box and select the Physician who will sign the note. If the Physician is not in the list box, you may manually enter his/her 3 initials (used in PRACTICE PARTNER Patient Records). This is a temporary solution to a missing Physician. After your Textcoder session, you should edit the Doctor.txt file to add the Physician (see Set-up Doctor file above).
G) Enter a date
The Date box displays the current date. The report will be listed by this date in
PRACTICE PARTNER. You may change the date to reflect the actual report date by
clicking on the box or by pressing TAB and typing the date in MM/D.D./BY format (e.g..,
05/09/96). IMPORTANT - PRACTICE PARTNER will not load 2 reports with the
same Patient name, same Date, and same Report type. When this occurs, change the date
of one of the reports.
H) Next Patient
When all of the boxes are filled correctly, click on the "Next Patient" button or press ALT-N. The current report will be coded and saved and a new report will be loaded. Now code the second report as you did the first. As you enter the patient's last name, the box will scroll to the nearest match. If the second patient name is not in the list box, press ENTER to update the list box. Scanning reports in alphabetical order can save some time here.
I) When you are finished processing all of the reports, Textcoder will save the file and notify you of the filename (current date. txt). This is saved in the directory C:\TXTCODER\out directory.
J) Exit
If you must stop Textcoder before processing all text, Textcoder will ask you if you want to save the reports that have been processed. All of the reports will be saved in the original encoded file regardless of your Yes/No selection. Select Cancel if you decide not to exit.
K) Manual mode
If you selected "Finding Reports Manually" in Settings, Change Settings, Textcoder will load 100 lines of text at a time when you click on the "Load Text" button. You will need to fill the list boxes as above, then place the cursor at the beginning of a report by clicking on the position or using the arrow keys. Click on the "Insert Dot codes" button. Then place the cursor at the beginning of the next report. Repeat this process until all the loaded reports are coded, then click on the "Load Text" button. The coded reports will be saved and another 100 lines of text will be loaded. Some reports will be split across two batches of 100 lines. You should only label the beginning of the report (not both sections). The report halves are combined back together during processing.
Special Problems
A) Multiple Reports loading in Automatic mode
If more than one report loads when you click on "Next Patient", code all but the first report as discussed in "Manual Mode" below. You must first select "Edit", "Enable Insert Code at Cursor" from the Menu. Textcoder disables Manual Mode after each report to avoid confusion. After all but the first report are coded, select the Patient name, Report type, etc. for the first patient and click on the "Next Patient" button. If you fail to separately code these reports, you may still manually insert codes after your Textcoder session using a text editor (see Coding Errors below).
B) Coding Errors
Common user coding errors include: loading two attached reports and failing to code them separately, selecting the wrong patient (duplicate names), assigning the wrong Report Type or Provider, scanning a report twice, and failing to scan one page of a report. These errors can be corrected after your Textcoder session by editing your completed coded file with a text editor such as Windows Notepad. Put aside the reports that need to be corrected and finish coding the rest of your documents with Textcoder. If a report is missing, write down the patient name for the report that was scanned before it. It may be attached to the end of the prior report.
Go to Windows File Manager and double click on your filename (today date. txt) in the C:\txtcoder\out directory. You can page down to the error manually or use Notepad's Search/Find function (search for the patient's last name). If you are comfortable with the dot code format, correct the name/account #, report type, Provider ID, etc. Usually you can just follow the format of the error-containing report. Spelling and the proper use of "periods and colons" are critical. See your PATIENT RECORDS documentation for details. If the dot codes are missing entirely (as when two reports are joined together) you can enter them manually, but be careful to format them properly. Alternatively, if you don't feel comfortable using dot codes, you may highlight and delete the error-containing report and re-scan it in your next scanning session. Be sure to search for any missing reports to be sure that they were not attached to the prior report (use the Search/Find function to search for the prior report and then try searching for a unique word in the missing report). When all errors are corrected, Save the file and exit Notepad.
Loading Coded Reports into PRACTICE PARTNER
Coded reports are saved in the C:\txtcoder\out directory and are named current date. txt.
A) Start PRACTICE PARTNER (if not already started) and select from the menu bar:
Tasks
B) Choose Data Loader
C) Choose Load Data from a Word Processor File (Don't choose Medical Writer)
D) The Browse to the C:\TXTCODER\OUT directory and choose you file to be loaded.
E) Click the LOAD button to then load the file. If everything goes OK, no errors will pop up as an error message.
F) Handling Load Errors
PRACTICE PARTNER will notify you about reports that did not load or that contained errors. A file is generated in the same directory you picked the file from (in this case, C:\TXTCODER\OUT). It will be labeled *.err. Errors in loaded reports must be corrected in PRACTICE PARTNER Patient Records. For reports that did not load, you may either ignore the error and Ruskin the paper report in your next scanning session, or correct the errors with a text editor and reload the reports. If you only have a few load errors, it is usually easier to Ruskin the reports in your next session. To correct reports that did not load, open Windows File Manager and double click on the filename in the \txtcoder\out directory. Make the corrections as follows:
1) Patient ID Different from name.
a) Cause - This occurs if a patient name or account number was changed in PRACTICE PARTNER but the Patient List in Textcoder was not updated, or if a patient name or account number was entered or edited manually when the report was being labeled.
b) Remedy - Correct the account number or patient name spelling (look up in PRACTICE PARTNER if necessary). Note especially spaces and commas. Also note that middle initials are not used.
a) Cause - Patient's account number is not present in PRACTICE PARTNER. This may occur if the account number was eliminated because two PRACTICE PARTNER charts were merged.
b) Remedy - Correct account number.
3) Duplicate text.
a) Cause - Two or more reports for a patient have the same date, chart section (.K: line), and title (.T: line) if used.
b) Remedy - Change the date of the report that did not load.
4) .T: line out of order.
a) Cause - The .T: line containing the note title was not on a separate line.
b) Remedy - Correct the .T: line to be on a separate line
When corrections are done, select File, Save, then File, Exit. Reload the file as above. Ignore the numerous Duplicate text errors that you will get for the reports that loaded successfully the first time. Check to be sure the corrected reports loaded.
Three types of files created while using Textcoder may need to be deleted periodically to free up disk space. CARE MUST BE TAKEN since careless keystrokes during these steps could cause irrevocable data loss.
A) Deleting Patient Inquiry files
These are generated by PRACTICE PARTNER each time you update your Patient List. These files (which all end in ".inq") are in the part directory of the system on which you run PRACTICE PARTNER. You can delete them individually by filename or as a group using wildcard characters.
B) Deleting Encoded Text files
If you set Textcoder to "Save copy of original file", you will accumulate these files in the \txtcoder\in directory. Change to the directory (cd \txtcoder\in) then delete the files by name as above or delete all files in the directory (del *.*).
C) Deleting Coded Text files
After files are coded by Textcoder, the files are stored in the \txtcoder\out directory. These files are named by the date they were processed, e.g.. "050996.txt". It is a good idea to keep these files for a few months as a backup in case a report needs to be reloaded into PRACTICE PARTNER (for instance, it might have been loaded into the chart of a duplicate-named patient). After changing to the directory (cd \txtcoder\out), some of the files can be deleted as described above.
Troubleshooting
Textcoder for Windows is designed to respond to common user errors. In most cases the user is notified of the necessary corrective action. In the event the program fails:
\txtcoder directory
txtcoder.exe
coder.cfg
test.txt
Doctor.txt
Patlist (created by Update Patient List)
index.txt (created by Update Patient List)
\windows\rlzrun20 directory
rlzrun20.rts
cable.dll
I:\PPART\intranet\Skyline Staff\Computer Procedures\scanning & loading paper documents.htm