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I'd appreciate you describing the process my very small office would go through in scanning paper charts into the EMR you sale or use:
I have 3 file drawers of charts. No manilla folders. Just a paper clip separating one chart from the next. No staples.
Organized in the following order from front to back: 1) Encounter Notes 2) Labs 3) X-ray reports 4) Consult reports 5) Signed papers for practice policies and pain contracts 6) Demographics 7) Insurance card and Drivers license 8) Super Bills already faxed to offsite biller
Some thoughts to consider in your answers: There are no bar codes on the current charts. Would they all be batch scanned into one file or would they be separated into the various categories mentioned ? How many specific steps involved? What are the steps? Be as specific as possible. How tedious would it be to keep the categories separated? (Is a separating paper with a barcode on it used to assign the category placement?) Would this project work if your EMR is an ASP ? Once scanned, how easy is it to find and view a part of the chart? (I refer to pain diagrams from previous visits and like to quickly skim over old notes before visiting the patient and would like to continue this process.)
Next question: Once old charts are scanned, what would the process be of entering new paper or digital chart notes? Would each new paper need a barcode on it? If using Windows Journal, what is the process of adding it to the existing chart? How about "Active Ink" chart notes , or notes created with OneNote?
I think I hired one of my girls to do some scanning. Well, now that Synapse files automatically, I think I will do it myself - it's lots of fun.
(1) Load Paper
(2) Press Green Scan Button.
(3) Laugh knowing other EMRs make you add staff to handle all the scanning !
*note: (3) is optional. I add it in.
My EMR is: Synapse It is what we know already that often prevents us from learning. Pioneers are the ones with the arrows in their backs.
Jason, you crack me up! Thanks for the short answer, but I was hoping for the specifics of a long answer! See my above questions as it relates to "Synapse files automatically". Any video demonstration?
What are the details? Does it scan to one batched file, or subdivided into the various chart categories? If automatic, how does it know to file in the specific categories I listed that my current paper chart has? etc.
Brendon answered this in his thread: http://www.emrupdate.com/forums/t/13101.aspx
"As stated the software we use in our back scanning is provided with our solution:
1. Bar Code Chart tabs with our production bar code software.
2. Remove Papers from chart.
3. Remove Stalples and put bar code sheets in front of each tab, place all of this in a stack
4. Scan the documents using our Enterprise Scan and Index production oriented scanning software.
5. Bar Code Server reads bar codes and places the Pages as one Document in each Tab to look just like paer.
6. Alternate final step, before visit use our high speed Chart Cleaner tool to move the documents to the correct DOS for easier review. This is often not done as the office goes forward, because after Step 1-5 (the backscan of charts) the chart looks just like a paper chart.
Hope this explains it. In other words you get the same high-end software that would be used for a large back scan project of 10,000,000 pages for your practice as part of our solution.
FPdoctor:Does it scan to one batched file, or subdivided into the various chart categories? If automatic, how does it know to file in the specific categories I listed that my current paper chart has? etc.
First off, let's get this straight. Synapse is the first AutoFiling EMR. Full stop. Wannabes are likely to follow (ie. those legacy EMRs @ http://www.cchit.org ).
Secondly, all I have got it filing is my labs so far. Essentially I just fed 30 sheets into my scanner, pressed the little green button (above) and my Scan Snap scanned them, Synapse detected the scans, and Auto-Filed them all.
How cool is that ?
This will obviously be the greatest time saver of all time.
Synapse will know what category the item should be filed under by the OCR rules. In this case it files in in my Labs - Scanned category.
Of course the good part is that you can make up the OCR rules for any type of Systematic Document. I will be tackling a few other labs next and then on to notes from consultants.
In the current iteration of Synapse AutoFiler, it relies up the systematic nature of some documents. However, Graham and I are thinking up ways to do this for virtually all documents.
/excited.
Jason,
Lets get something else straight. While we are proud of what you and your comrad Graham are doing with OCR, it is not new. We offer many front ends to our EMR that we have developed via OCR/EMR toolkits and we are a Captiva Reseller.
http://www.emc.com/products/family/captiva-family.htm
I think it is a bit ridiculous to make such a statement, given the rudementary nature of this technology. i was very proud to see that Graham had incorporated this. I said wow, by George hes got it.
But really man, this is truly unremarkable in and of itself. No matter how you look at it many bubble forms, OCR/ICR/OMR technologies have been incorporated by many EMR companies, not just eMedRec. SRS software and Sage/Medical Manager did it with OmniChart.
Don't let this diminish the value of Grahams add-on technology, especially given the fact that Graham charges nothing for his EMR. I still wonder why he is so dedicated to providing complex, not so free technology to people for no price.
That in and of itself is great.
Make no bones about it OCR/OMR/ICR technology is cool, but it hardly replaces completely all of the filing for large practices with volume. It will help with forms based inbound documents that have fields that can be identified. That being said, many of these forms can easily be processed for Labs, Hospital Reports and Diagnostic Results or even outside inbound Transcribed notes from other offices.
In reality this is somewhat cool, but most EMR's will directly import a lot of the labs, can get interfaces with Hospital Systems and receive Diagnostic and Equipment Results automatically.
Other then that this technology is relatively uneffective in auto filing anything.
It does work, and it is great you guys have stumbled into this age old technology, but please don't insult all of us in the industry by making it look like your on to something noone else has though off.
Have a good night gentleman,
Brendon
Brendon: Lets get something else straight. While we are proud of what you and your comrad Graham are doing with OCR, it is not new. No matter how you look at it many bubble forms, OCR/ICR/OMR technologies have been incorporated by many EMR companies.
Lets get something else straight. While we are proud of what you and your comrad Graham are doing with OCR, it is not new. No matter how you look at it many bubble forms, OCR/ICR/OMR technologies have been incorporated by many EMR companies.
This isn't simple OMR, so let's not compare AutoFiling with OMR. This is also not just OCR. I never said Synapse was the first EMR to have plain OMR. I said it was the first EMR to Auto File incoming paper by allowing the enduser to make up rules to do the filing.
Filing items that are barcoded will be considerably easier, we've taken on the hard stuff first.
Synapse already has HL7 interfaces if you want to connect directly to labs. Graham does that already.
The vast majority of EMRs do not offer autofiling.
Q: Does eMedRec autofile items without a barcode? You really never answered that question.
DrMurdoch: The vast majority of EMRs do not offer autofiling. Q: Does eMedRec autofile items without a barcode? You really never answered that question.
You're asking EMR's to take steps backwards? Whatever Graham does with Synapse is up to him. He's a smart guy and I'm sure the feature will have utility. But, come on! Don't all of a sudden expect that all EMR's should take a step backwards because some hospital laboratories are hard to work with on HL7 interfaces.
>>Synapse will know what category the item should be filed under by the OCR rules. In this case it files in in my Labs - Scanned category.<<
But, it only scans to a category like Labs? Maybe EKG's? Maybe 20 other areas...how does it get to the patient level? Are you eliminating human intervention after hitting the scan button?
I have a hard time agreeing with you in that CCHIT EMR's will follow anyone on this feature. They already have HL7 interfaces built in...
It's a nice feature but I have a hard time believing other vendors will spend time and money investing in this.
bbchase: Are you eliminating human intervention after hitting the scan button?
Are you eliminating human intervention after hitting the scan button?
Yes.
Scanning in paper in a chartless EMR is 100% inevitable. Not all labs will send HL7. Sure, use HL7 when you can, but when you can't ? How can I use HL7 labs for consultants that dont even have computers (they dictate, print and mail) ?
Absolutely, via our import server we can grab faxes and process them into directories that are then processed via cuatom modules that utilize Forms Technology, know as OCR Zone Based Technology. In the Document Management industry this is old news. Obvisouly you have known this all along, as there are literally over 40 products on the market and several tool kits that allow this:
http://www.leadtools.com/SDK/Document/Document-Addon-ICR.htm
http://www.pegasusimaging.com/formsuite.htm
In addition as I stated we have developed for practices, banks, and even Palm Beach County Parks and Recreation Handprint and Zone Based OCR/ICR solutions for over 15 years. Like I said this is not new technology. In reality, not only does eMedRec do OCR/ICR as a Add-On, but further it then creates Manual Batches for those outsorted Items with OCR/ICR Zone Base High Speed Key Indexing by zooming in on the other section.
What is incredible about your offering is that it is free, like Grahams EMR itself. Our version would cost around $2,500 for a small practice and up to $5,000 for a large practice handling aroung 2000-3000 pages per day through the OCR Software. We currently have a billing company using this as a front end to our Enterprise Document Workflow that handles around 80,000 pages a day for over 50 hospitals that uses OCR/ICR with Barcoding to automate indexing for billing as much as possible.
Therefore, to answer your question yes. We just never considered this a marketable feature. We thought rightfully so, this is old technology well know in AIIM and other Content Management Circles, like Oracle, IBM Filenet, Onbase, etc.....
http://www.captovation.com/captovation_recognition_server.htm
On Base via third party support, like us:
http://www.onbase.com/English/Products/OnBaseProductModules/ImagingCaptureModules
Filenet from IBM, you can dig through the pages to find where they buried this feature, they obviously have it:
http://www-306.ibm.com/software/data/content-management/products/content.html
I know Sage had it in early products of Omni, can't find it here:
http://www.sagehealth.com/wps/wcm/myconnect/sagehealth/www.sagehealth.com/products/ehr/intergy_ehr/intergy_practice_portal_features_and_benefits
Allscripts offers this as part of the ImpactMD product line:
http://www.allscripts.com/products/physicians-practice/solutions-document-imaging.asp
You get the point, anyway I will let you guys bast in your glory and not rain on your parade anylonger. Cannot wait to see this when it is past version 1.0 screen shot you demonstrated the other day.
Like I said what differentiates you is not what you are doing, it is that you are doing it for free.
Or at least I understand from what I remember when he started it was free.
Brandon,
They already have, it is a standard feature as part of a project for many EMR/EHR solutions. It just is not core to the product. Your company could offer it to. Simply sign up as a Reseller for EMC/Captiva software and you could offer a very complete 15 year old product based on the original Genisis product that will process forms of any type, with a very mature front end for $2,500 for each practice.
Here is the link if you want to just support this via third party as we have since we have resold Captiva (Now EMC) and OCR for Forms (No longer support or sell this) for over 10 years.
http://www.emc.com/products/detail/software/inputaccel-express.htm
You could even setup Labs that are faxed in from third parties without HL7 INterfaces like Jason said and capture the data, all of it in a zonal fashion and store it just like you received a data lab. You would have to do some zone work and filtration, and probably would have some correction phase, which is a user input process, but you can do it.
Don't worry, many vendors have this covered. Jason is right, in that it is cool, but hardly something you should develop when so many third party products are out there to meet this need. It would take you a long time to get a product equal to that of Captiva and it is not that expensive. If you did want to develop it you could put it in your product in under a month, easily, just use:
They have been asking us to embed it in eMedRec, and I think I will go ahead and do this. Most of our customers have not demanded it and it is not as perfect as Jason is alledging. It will add substantial costs to the product, that is why I am impressed that Graham is giving this expensive technology away for free. Further, these toolkits will provide all of the front end necessary for forms design, registration and processing of OCR/IMR/OMR information. Matt would simply just have to call the routines.
I would have to download Grahams technology and test it to really know if what he is offering compares to that of these production oriented products or if it is Beta 1.0 standard OCR ZOne recognition.We have done this with Leadtools for the banking industry, we can easily move this into our product. It has just been easier to have them get support via a third party product and let the third party product be improved by a separate set of developers.
I was not going to say anything in this thread, but Jason really put some bold words out there thinking they had something new. He knew better, he has been looking at document management for years, I was surprissed he made such a bold statement knowing how he even knows how old this technology is. It has been used in Banks, Healthcare, Finance, Claims Processing, Insurance, Government, nearly all types of business for decades.
Regards,Brendon
DrMurdoch:Filing items that are barcoded will be considerably easier, we've taken on the hard stuff first.
Actually, that is not true. Your right about the reading part, but then again you add a cost, because technically you will need to license this technology per server. But more importantly you need a forms designer that wll allow for the drag and drop of fields onto forms so that you can have dynamic paper.
Good luck with this one, it took us years to develop our own Forms Designer that integrates the Appointment Data, Previous Problems and Medications, Insurance Data, financial data and literally 100's of fields that can be dropped on a form, including one field that is a barcode for the form to tell it Who's chart, where in the chart it goes, and does it need to be routed to a user or group (Workflow).
I am impressed you have Graham going down this road. I cannot wait to see the end product in another 6 months to a year.
I cannot believe you do it for free. Why Graham do you do this for free. Is Synapse really free, or are there any costs.
Graham,
You are amazing, this is free. I went to your site to see if you charge for support, I got the following error on your support page:
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Jason and Graham,
I love Graham, I think it is really cool that he is so pro EMR he does it for free out of the kindness of his heart.
Be clear here:
What is amazing is not that you guys have done this, it is that you have done it for free.
I would love to meet Graham someday, obviously he is a man of pasion and has deep pockets. I love a man who has conviction and is willing to back it up.
I'm out, I will return the thread to you to push as you have.
With respect,Brendon