$$ - Scanning workflows

While the scanning functionality implemented in the various clinical software packages vary somewhat, nearly all software options on the market allow documents to be scanned directly into a patient file one at a time, or scanned using third-party scanning software and later linked to the appropriate patient records in a batch.

This article outlines these approaches in more detail, and also includes some tips for practices considering the process of scanning their patient record archive.

Scanning to the patient file directly

This workflow typically involves opening or nominating a patient record in the clinical software, scanning a document, and finally, giving the resultant file a name or description. The file is automatically linked to the patients record for subsequent retrieval by the clinicians in the practice.

This approach is often utilised in Specialist practices as it allows, for example, a referral to be scanned by reception staff at the time the patient presents for their appointment. GP practices may find this “real-time” approach to be effective also, however results will vary widely due to factors such as patient throughput, staffing levels, and front desk ergonomics. This ad hoc scanning approach is also efficient when only a few documents need to be scanned, however it isn’t a recommended workflow when a large collection of documents require digitization due to the overheads associated with manually opening or nominating patient records.

Batch scanning

Batch scanning describes the process of scanning a collection of documents and saving them as files, and at a later time, linking these files to the appropriate patient records in the practice’s clinical software. Batch scanning will be the most efficient way to process a collection of documents associated with a set of different patients.

Most scanning software will allow the user to fill the document hopper with pages, press a button, and walk away and attend to other tasks. Under this arrangement, the following is possible:

  1. each page can be automatically saved as a discrete electronic document; or
  2. all pages can be saved into a single electronic document.

It will be well understood by practice staff, however, that neither of these outcomes are ideal. In the first case, multi-page documents are separated into multiple electronic documents. While each page can be linked to the patient, or the files may be first merged into a single document prior to linking to the patient record, this is ultimately another step in a process that is arduous enough! In the case of the second option, staff are restricted to putting a single document associated with a single patient into the hopper before scanning. As a result, the process needs to be repeated for each document and the efficiency of this “batch scanning” workflow is undermined significantly.

Fortunately, scanning software exists that allows “separator pages” to be placed between each document in the hopper, allowing documents for different patients of to be scanned sequentially, regardless of their length.

These separator pages are typically generated and printed to A4 paper by the scanning software, and simply feature a unique image or bar code that, when scanned, indicates to the software that a new electronic document needs to store the subsequent pages.

By using software that supports separator pages, practice staff are able to place an entire hopper load of pages into a document scanner, initiate the scanning process, and have created for them a single file for each logical document placed in the hopper. The resultant electronic documents can then be linked to the patient records in their clinical software.

For this process to work, clinicians and practice staff need only be “trained” to place a separator page on top of each document placed in the “to be scanned” tray.

While a detailed discussion is outside the scope of this article, it should be noted that separator pages can convey far more information to the scanning software than just the fact that a new electronic document needs to be started. By no means an exhaustive list, different separator pages and associated scanning scripts can be created to tell the scanner to do one or a combination of the following:

  • Scan the subsequent document at a specific resolution.
  • Scan the document in colour instead of black and white.
  • Scan both sides of the page or just the front.
  • Use a specific naming convention for the document.

Regardless of the clinical software package you use, it is advisable to attempt to establish a workflow where only one of the following has to occur manually:

The naming of the scanned document file.

Entering a description (meta data) of the file in the clinical database to facilitate easy identification of the document by the clinician.

Given that it is feasible for scanning software to automatically name each document with a date and time stamp (or other naming convention), but not possible for said software to intelligently input meta data into a clinical database, it is the author’s recommendation that practices use an automated file naming process and undertake to manually enter meta data about each newly imported document. Once stored in, or linked to, your clinical database, and superseded by document meta data, the file name of the electronic document will cease to have any relevance to the clinician.

Retrospective scanning

While many practices are now endeavouring to scan all new incoming documents, a much lower number have undertaken the task of scanning their existing patient files.

Typically undertaken using a workflow that resembles the batch scanning process outlined above, the shear size of the task of retrospective scanning warrants the mention of some specific tips:

  • It goes without saying that the scanning of one’s paper patient records archive is unlikely to be a trivial exercise. Before committing to such a task in earnest, it is recommended that the practice pilots the endeavour by scanning a selection of their patient files — all patients with a surname starting with “A” for instance. The hours involved in this pilot should be tracked to allow for an accurate cost projection to be calculated for the scanning of the remainder of the patient records.
  • Don’t even consider retrospectively scanning patient files with anything less than a $1000+ dedicated document scanner — a lesser device will simply not have a duty cycle capable of handling the shear volume of documents. Even if you are in possession of a scanner purchased in this price range, hiring a more robust scanner with a purchase price tag of over $5000 for the period is likely to provide the best results.
  • Due to variable paper sizes, paper condition, staples, paperclips, glue, sticky tape, and other “scanning nasties”, practices should expect that the preparation of patients files for scanning will takes longer than the actual process of scanning the file. For this reason, assigning two staff members to work on the task simultaneously is advised where possible.

While selectively scanning parts of a patients file is possible, the fact that a clinician would need to be involved in the process of vetting each file relegates this to being unlikely. Further, scanning only a portion of the file effectively prevents the files from being destroyed, and for these reasons, it is the author’s opinion that scanning entire patient records is the only practical approach.

Practices that have done this, and have subsequently destroyed or archived their paper notes off-site, report having benefited from increased space in their practice and have effectively eliminated the administrative time spent retrieving and storing paper files.

Conclusion

From a high level, this article has outlined three well known and established scanning workflows, and made some recommendations as to how each of these may be optimised.

Of course the ideal scanning workflow is the one where scanning doesn’t have to be performed at all! Secure messaging can reduce the amount of paper flowing into and out of the practice. While admittedly not a simple undertaking due to the variety of competing, non-interoperable solutions available on the market, there are recurring and exponentially increasing efficiency gains to be realised by practices that are able to open secure electronic communication channels with the healthcare organisations and providers with whom they currently correspond with using paper.

Posted in Australian eHealth

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