This scenario assumes that PaperPort is installed. If you don't have PaperPort, you must have some other type of scanning software installed. A scanner is naturally required. If your scanner scans directly to a specific folder, see the next post for a short cut method. 1. Select the patient ( use the "Search" button at the top of the screen ). And then move to the Patients/Results tab. 2. Click on the "PPort" button. This will bring up PaperPort to the directory where your PaperPort files for this patient are stored. This is configured in the Settings/PaperPort tab. The patient directory is created if it does not exist. 3. Scan your document, noting the name of the file created. 4. Click on "Add New" to bring up the "Add Result Window" window 5. At top left, select the clinician for whom the result is destined. 6. Select a test date. Using the "?" button brings up a calendar. 7. Select a Result type, or type in a type in the drop down field 8. Type in a short synopsis of the result. 9. Click on the second "?" button next to where it say "To be viewed in a web browser" 10. When the file requester comes up, do a Control-V paste into the requester where it is asking for a file name, and the patient's paperport directory will be pasted there. Hit enter, and the file requester will now show the patient's paperport directory. 11. Select the file you want and then click on "Save" in the file requester. 12. Click on "Save" in the "Add Result Window", and the progress meter next to the save button fills as the file is transferred to Synapse-EMR server. 13. You can now close the "Add Result Window" unless adding more results. 14. Note that you can not add the same scan twice - the server will tell you that the file already exists. 15. To now add results for a different patient, click on the top "Clear" button, and enter the different patient details. As you remain on the "Results" tab, you can quickly start adding results for the different patient.
Build 178 adds a scanner directory preference ( see Settings ). Many scanners will scan at a touch of a button on the scanner and place the files into a specified directory. If we wish to add that scan to a patient's results, we only need to find the last scan in that directory. There is now a new button in the add results dialog named "Last Dir" which accomplishes this. It places the name of the last file added to your scan directory in the field ready to be transferred to Synapse EMR. You can then use the "Save" button to do the transfer.
I have been using Paperport to store patient data as PDF files. Each patient has a directory LLLLL,FFFFF with subdirectories for Labs, Registration, Visits and Reports. A fax is printed as a PDF file and manually stored in the apropriate patient directory. SnapScan is used for most scans. It produces PDF files that are stored as before. An Epson flat bed scanner is used for photos. They are either stored as PDF or jpg files. I store my files in the Synapse database as per the method described below. 1. Select the patient ( use the [Search] button at the top of the screen ). BUTTONS ARE ENCLOSED IN BRACKETS [ ]. 2. Click on the [PPort] button. This will bring up PaperPort to the directory where your PaperPort files for this patient are stored. This is configured in the Settings/ (PPort/Scans) tab. The patient directory is created if it does not exist in the format ...\X\LastName,FirstName where x= 1st letter in LastName. Click the Settings tab. Select the "More Settings" tab. In Patient Directory click on [..] and select the proper directory. For example: n:\Medicare\. For Mr. John Simith the following directory will be generated n:\Medicare\S\Simith,John. In Scan Directory click on [..] and select the directory where you will store your scans. You can actually import from different locations if you so desired. The program will always default to the Scan Directory. 3. Move to Results tab-> Text Results tab. 4. Scan your document, noting the name of the file created. 5. Click on [Add New] to bring up the "Add Result Window". 6. At top left, select the clinician for whom the result is destined. You can make him/her the default. 6. Select a test date. [?] brings up a calendar. 7. Type or select from the drop down field a Result Type. 8. In the Description type a short synopsis or a short interpretation of the results or select [Normal]. 9. Click on [..] located next to [Last Scan]. Select the file you want to open. The location of the file will appear in the File Name box. My files are named "Result date". Date in the format mmddyy. Example: Mammo 052206, for Mammogram performed on May 22, 2006.. To enter the file I follow a reverse order Step # 9 ->Step #6 -> Step #7 -> Step #8. 10.Click on [ Synapse Import] and watch the progress meter fill as the file is transferred to Synapse-EMR server. 11. You can corroborate the transfer by selecting the main window and observing a new entry in the Test Results. You can check the data by clicking on [View Image]. 12. You can now close the "Add Result Window" unless adding more results. 13. Note that you can not add the same scan twice - the server will tell you that the file already exists. 14. To now add results for a NEW patient, click on the top "Clear" button, and enter the NEW patient details. As you remain on the "Results" tab, you can quickly start adding results for the NEW patient. I hope this modified explanation helps. Please check these instructions and modify accordingly. DrO
DrO, Your description is good if the person doing the transfer to Synapse is also the person doing the scanning. If you have scanned files into PaperPort, then at step 9, click on the "Open PPort File" button instead and this allows you to more quickly open the right file. There is no need to verify the file transfer in step 11 as the status will tell you if the transfer is successful or not. When the scan is complete, the patient details are cleared. You can then switch to another patient by using the Quick Search popup .. mine is set to F3. If you are not the person scanning, then steps 7, and 8 follow step 9, because with the file name showing, you can now browse to the file using your internet browser to view the details. Hope that helps.
The above assumed users are using paperport. Itdoes appearconfusing for people who don't use paperport. Now I figured out ways to do this with and without paperport. Paperport does make things earsier. Maybe move the [..] button next to [last scan] to the right side of file name box? This way users who don't use paperport will know at a glance how to add an attachment. Paperport leaves 3 other files .ptn, .ptn2 and .ini2 in the scanned file directory, Synapse only deleted the .pdf file after importing. You will have to manually clean up if you wanta clean drive. Comments? If I want to save an .iso file, is there a way to save the file link only without uploading the whole file? And, mark the three required fields in color?
It's probably not a good idea to save the whole disc. I will probably save the key images as .jpg in the future. We are not radiologists anyway. Just curious, what resolution and picture type you guys use? For text, B&W 200dpi seem to be good enough, grey scale looks better but results in much larger file size.
I use 200 dpi with grey scale ... because it looks awful in b&w. Really odd because my really old HP parallel port scanner works fine in b&w .. and my much newer HP usb scanner gives a lousy picture in b&w.
What are we talking about here ? CT scan reports ? or Images of a PA/Lateral Chest xray ? I scan everything in 200dpi Black and White with embedded OCR text. I am looking at a one page note from a consultant that is 34K. It is perfect to read and I can highlight, copy and paste the text of the note for my use. My files are scanned in PaperPort 11 and I use the "PDF searchable" file option that is available for those PaperPort users that have Omnipage. I have Omnipage 15. I *still find* PaperPort 11 tends to give me problems. It seems to bog the computer down more than it should. PaperPort 9 was "less networkable" but I don't need PaperPort to do my network filing anymore as Synapse does my filing (into Synapse) or to the patient's folder (when it doesn't need to be in the patient's chart). I really like my PDF searchable files. I am looking into using Acrobat 7 Pro to batch convert my PDF images to PDF with OCR'd text. I don't find Acrobat's OCR is as good as Omnipage, but it'll do. I am looking into the option of "batch converting" my 17,400+ .pdf files from PDF images to PDF searchable (PDF files with OCR'd text embedded). I was able to do it with Acrobat 7, but I didn't like how it changed the dates of my files. I am not sure if I can retain the .pdf's original date. Here is a picture of my Scan Profiles in PaperPort 11. edit: http://www.hsonet.org/PaperPort11.scan.profiles.jpg 80 % of sheets are Profile 1 (top of the above list). 10% are Profile 2. 7% are Profile 5. 2% are Profile 3 1% are profile 4. Here is a bit of a breakdown of my incoming documents and how I use my PaperPort profiles to make nice B and W files.
cool jason, just the information I wanted. Tested searchable PDF, worked very well at 200dpi BW with my HP 4670 scanner at home. Hope it will work equally well with our Brother MFC in the office.
Questions for Graham, Jason and DrO, Are you all now paperless or do you still keep paper charts? How do you handle administrative scanning, e.g. insurance cards, letters from insurance, referral authorization forms? I suppose these can use plain PDF and don't need to searchable. But it kind of annoyingmix them with labs and test resultsunder results tab. I noticed Synapse server put all scanned files under "cache-listener" folder and adds the patient's ID as prefix to the file name, is there a potential performance problem once you have thousands of files in one folder?
Nophysical charts in my office.I never had them. <u>Insurance Cards</u>: we don't scan them here in Canada. Neither would Graham I suspect. It seems every office in the US does this, so I think Synapse should have a prominent spot for this. I think the real reason it hasn't been done thus far is we don't know much about it. Could you start a new thread on how these cards are used in an office setting ... or is it just a simple - scan it once so there is a record, but you never look at it again ? Exactly what key info is on them ? Of course, you could always put them in the patient's folder. <u>Letters from Insurance Companies</u>: I do have a manilla paper file folder with blank insurance forms that need completing. <u>referral authorization forms</u>: well, as a doctor in Canada I can send anyone anywhere for whatever reason I see fit. [] I take it you have to ask an insurer from time to time permission to refer a patient ? or are you waiting for the OK so you can get paid. Maybe you can explain what they are and how you use them, and how it could be integrated into synapse workflow. Don't attach non-medical "JUNK" to Synapse. It is a bad mix as you say. I put stuff directly in the patient's folder from the scanning computer (you do know there is a button for that ?). One issue I do have is teaching my secretary what to put in the patient's folder directly or what to scan into my InBox. I think the ideal situation would be to put everything in the INBOX, but that it is easy for me to move a result OUT of synapse to the patient's folder. Another option is for there to be a message sent to me that a certain item was filed in the patient's folder. In primary care, I have alot of stuff that I never want to see again regarding the patient. Heh. I asked Graham the same question. I have alot of stuff in there and I sure haven't noticed any performance problems. Graham feels that a performance problem is very unlikely. I tend to agree.Since all files have the patient's unique synapse number in the filename our backup solution is to write a script to dump the files in alternative locations (maybe one directory per patient). I can see how that would be a fairly simple script.
NTFS can store 2^32 - 1 files in one directory. That's a heckavua lot of files!! Now, Synapse server doesn't search for a file, it maintains an index to files by filename. NTFS has it's indexing scheme .. using B+ tree. In other words, NTFS is a database of files .. so there's no need for us to split files into multiple directories. Keeping it all in one directory also means it is easier to do backups of all the scans. If you are approaching 4,294,967,295 number of files in the scan directory, let me know ( if I am still alive! ), and I'll make some changes[A]
I am chartless. ( well, i have shelves and shelves of old files but I don't plan on doing anything with them ). I don't get much administrative stuff .. I just normally toss it. I may think of scanning and storing them.
There are a lot of paperwork involved in dealing with insurance companies. In our office, all the insurance cards are copied and put in charts and the information like policy number and type will be used for billing in our PMS. When patient change insurance, the new card is copied. Some insurance require PMD to fill a referral form before the patient can see a specialist. Some require pre-authorization for a test. Auto-insurance and worker's compensation needs authorization for almost everything. If they deny a test, we may appeal. So a lot of waste of time, energy and of course, all the correspondences are stored in charts. If we don't have them? we will not get paid. These are clearly JUNK, but we can't discard them. Let them stay in scanning computer is a solution, but then it's not felt to be part of the database and will need a separate back up plan. Some of them should not appear in MD's inbox but many of them do need to be filled or signed by MDs. To borrow from other EMR's design (the ones written by americans), maybe a separate tab can be added for these and the scans will just be filed and don't require a recipient.
