saving scanned charts one large PDF

[jrpappy]

I just got my Fujitsu scanner in the mail, and have been playing with scanning documents into the image section of the patient chart. It works great. I have been scanning multiple pages as pdf files, then saving them directly to the patient file in open dental images on the server. Then it's a matter of putting them in the appropriate image file.

As I was weeding thru a few charts, I realized that most of what I'm scanning is for archival purposes only, and will rarely be accessed. (About the only thing that I may want to look at are radiographs, and I'm not yet sure of the best way to scan these. I'll probably just keep the hard copies for now.)

My question. Does anyone see a problem with putting all of the old documents into one image file called 'Old Chart"? It would certainly be easier to scan one stack of documents rather than scanning individual stacks of documents and placing them in individual image folders. It would then be a matter of scanning thru the pdf in the same way you might flip through a chart to find what you are looking for.

My only fear is that until images are secured from accidental deletion (a feature request I believe), a few errant clicks could delete a patient's entire paper chart history.

Any comments?

[enamelrod]

i have requested the ability to archive folders and have security for individual folders, for that very reason, but your backups should take care of any accidental deletions. i think jordan said the archival of folders and security on folder levels has limits because of the limitations of linux and this feature would be hard to accomplish.

[enamelrod]

and by the way epson workforce s50 is cheaper and does the same thing and same speed.

[Rickliftig]

jr

Certainly good questions. I read that one of the western states just passed a ruling that charts need to be kept for thirty years! Between my Dad and myself, we had over fifty years of records to deal with. The pre-1980 ones have been shredded, and the records from 1980-2000 will be left in the dungeon (uh, basement).

I have kept (and still generate) a file folder for each new patient. In these, I place radiographs (still analog), a quick printout of the of the OD chart and probings (why, I don't know) a blank sheet for recording the date of the appt (again, why, I don't know!) a copy of the registration form, original medical and dental history and any eobs. Notes from referring doctors are scanned in, and filed in a big file folder. Those with radiographs attached, are placed in the file folder.

Now that I write it all down, I guess it's time to simplify these folders - but they are a good catchall for now. They make my front desk happy that there is still a piece of paper in her hand. And honestly, for something like an eob, I'm not sure it is worth the time and trouble to scan in. My front desk has not ordered a paper appt book for next year and has told me, "the paper is just a lot of extra work" - That's a big step for her (she ran them in parallel for about a year and a half).

I have no plans, now or in the future, to scan in old charts. And I still find it easier to visually look through them (ie. not on computer) for prior treatment. Any tx from 2000 on has been imported into Open dental and then I can easily find a date (using show tooth filter) and go back to the paper chart. Again, for the amount of time vs, the benefit, I can't see doing it.

One suggestion that I do have as per radiographs, is to take a jpg of the most recent fmx and place that in Open Dental.I use a Pentax Optio W80 ($165) and a viewbox.

The new crop of sensors looks promising and I am sure there will be a price point where it will make sense for me to go digital, but it's not there, yet.

I am looking forward to this next generation tablet/ipad and OD 7.1 to further streamline the input of registration and med hx.

Consider it a work in progress.

[jrpappy]

Thanks for the input.

Enamelrod, I guess I'm not sure how my remote backup really works. I always assumed that it overwrites every night, but that's probably not right. The fear would be that if an individual chart was deleted and not noticed, by the time it was needed the backup would be overwritten with more recent changes. I'll have to talk to my IT guy. And thank you for the scanner suggestion.

Rick, I've made a push to switch completely from paper to paperless since I started with opendental. I choose OD because it is so well suited to paperless. My staff loves it, charting is easier, and the patient flow is streamlined. I bought the Dexis sensor which was a hard pill to swallow, but the thing is amazing. We only have one sensor, and the size seems to work for all indications. The resolutions is so good that I see things I never would have seen with analog, and the patients and staff think it's cool. Will it actually pay itself off before it needs replacement? I don't know that. From a dollars and cents perspective, I guess analog would still be a lot cheaper, but so is a paper practice. I feel that the practice of dentistry is just much more expensive today than it was 20-30 years ago.

[jclaydds]

jr

We do something similar to what you propose -- scanning chart into a large file. I would recommend you consider if there are parts of your old chart that you feel you might refer to often. If so, you might want to scan the chart into 2-3 files so you can easily access the part of the chart you often look at. For us in our office, it is the most recent medical history and the old treatment notes. We have made different image categories such as Medical Histories, Treatment Notes - Old Chart, and Misc Documents - Old Chart. You mentioned having a Fujitsu scanner. Another post mentioned an Epson scanner. I am not familiar with the Epson scanner but I'll give my highest recommendation to the Fujitsu ScanSnap S1500 (~$420). It only will scan to a PDF file (not Twain compliant) but with the PDF support in Open Dental -- We love that scanner! We actually have 3 Fujitsu scanners (2 Scansnaps and 1 Twain) and love them all. We went with digital x-rays nearly a year ago. At that time, we decided we wanted to stop pulling charts, filing charts, carrying around charts and losing charts. Our process is we take out the medical hx, scan it and then import it into the appropriate image category. We do the same for the old tx notes. It could be multiple pages (35 year old practice) but they get scanned into a single file and imported. Finally, we take everything else we want to have access to (tx plans, correspondence from specialists, etc) and it all gets scanned into a single file and imported into Misc Documents. As far as old x-rays, we only scan in the most recent FMX, panorex and the most recent BW's. I know Rick mentioned putting the films on a viewbox and taking a digital photo of them. I went with a more expensive solution -- unsure if it is better -- just know it costs more. I use a Epson 10000XLPH scanner. It has to be the model with the PH at the end. It has a transparency adaptor that you need to scan x-rays. This is the only scanner on the market that I know of that can scan an entire FMX without cutting off part of it. We lay the entire FMX (in the mount) in the scanner and scan it. It retails for 3K (ouch!! --I know it was painful!). I found mine on ebay for just under 2K and there is one on there now for $2250--"buy it now" with free shipping. If the camera and viewbox works for you -- I know it would save you lots of dollars. I was looking at it from an efficiency point of view and felt that since I wanted to scan in all these x-rays -- my labor costs would hopefully be less assuming that the scanner process would be quicker than the viewbox/camera. I can't argue which way is better, faster, or which gives you the best quality image, etc.

I don't have anything I need to do with the space where we store the charts and being the OCD person that I am -- I can't force myself to get rid of them. Since I am not scanning parts of the chart (old perio charting, older medical histories, etc) and I am only scanning the most recent x-rays, I think to myself that I might potentially need that information if I were ever involved in litigation with a patient, etc. Occasionally, a scan is not legible and it just gives me a warm fuzzy feeling to know the chart is back there if I need it. We rarely do -- we are almost a year into the scanning process and I bet I don't handle a paper chart once a week. Incidentally, our method is to try to get the scanning done on the patients as they come in. We never tried to scan all the charts -- just those that have appointments. Since we are nearly a year into it, I would imagine we have scanned well over half of our active patients. I have no interest in trying to scan every chart -- there are undoubtedly thousands of charts of people who are never coming back (moved, dead, mad, ??). When we scan the chart, we place a note under Service Notes that "Scanning of Chart Complete" and the initials of the staff member who scanned it. The front desk checks that area of the chart for the patients coming in that day and pulls any charts that don't have that notation. Our assistants and hygienists all pitch in and scan when they have free time or a cancellation on their schedule.

I'll also tell you how we handle EOB's. For every EOB, it is easy to see on the entry in their account what date the payment was posted or the date of the note even if no payment was made (applied to deductable, inelgible for benefit, etc). In other words, you should be able to find the date that this happened which is the date the EOB was recorded into account. We take every EOB that we received today and scan it into a single file (EOB_2010_06_03.jpg) If we need to refer back to an EOB, we go to the account and see what date it was posted and refer to that file. We are slowly getting away from paper -- we at least shred the EOB's after they are scanned.

All incoming letters from specialists, photos, x-rays are scanned in and then shredded a few days later. That will give you a sick feeling the first time you do it. My front desk will at least wait a couple of days to make sure I have reviewed the scanned images before they shred the original documents in case I want to look at the orginal x-ray, etc. I rarely need to do so. After scanning the letters or other items into the appropriate image category, my front office staff will send me a task in Open Dental to review them. I will often make a note in the chart or on the task (also shows up in chart) that I have reviewed it or a note about the content of the letter if necessary. No more piles of charts on your desk with letters paper clipped to them.

More than enough info for now -- Hope it gives you some ideas you can use and not just insight on my OCD tendencies.

Jeff

[afeuer]

My 2 cents.... We went as paperless as possible this year. It wasn't a huge deal for us as we have had digital xrays since 2002 and digital charts since 2004. The big difference in our office from other opinions so far is what we do with the paper that comes into the office. First we scan everything possible into the patient chart. For large EOBs with many patients we scan them in by date into a chart that is the name of the insurance company. It is easy to look at the date received and go and find the EOB if necessary. We've been scanning since January and everything seems to be working very smoothly. We use the Epson gt-s50 (we can scan insurance cards/drivers licences also) for everything.

The big rule we have is that we don't shred any paper that comes into the office (unless it's not important)! We have about 6 or 7 folders with generic categories. After we scan the EOB, referral letter, ect. we will just file them away in one of these folders. Whenever the folders get full we date them and put them in the attic. We have only had to go to the folders once, but it was worth it. I'm not sure how long we are going to keep all the paper, but we feel so much safer keeping them around as a backup.

As for paper we generate, we try to generate as little paper as possible. Anything we don't need anymore we shred. Our biggest paper waste now is bills and recall postcards.

Oh and we are scanning in old charts little by little. We don't scan in everything though. We almost never scan in xrays because we've been digital for so long. We also don't scan in any EOB's or things like that. All we scan is the paper chart and letters from other Drs. We scan them into one big pdf always in the same format. We just have our from office person do it whenever she has free time. We're in no rush, but we want to get them out of our front office. We're about 1/3 done.

Backups.... that is always a complicated topic. First we do lots of different types of backups. We keep local differential backups (full backups) at regular intervals. This takes up a lot of space, but it is easy to restore to any date that we did a differential backup. We also do an offsite mirror backup and offsite incrimental backups. This also allows us to keep an exact replica of the office and allows us to restore to any previous date in time if needed. Another way we are able to keep a sudo backup of our scans is that when we scan something it goes into a folder saved as a pdf and the name is the time and date. We then import the file into OD but we don't delete the original scan. We have a large archived folder of all of our old scans. I think we've pretty well covered our butts... knock on wood.

Hope that helps a little.

-Adam

[Jay]

To revive another old thread, did anyone end up comparing a scanned FMX to Rick's idea of photographing it on a Lightbox? I like the photograph route for obvious reasons (cheap and quick) and I might add even quicker if one uses the Twain interface and a twain compliant camera for direct import in one click.

[Rickliftig]

Jay - the resolution of the photograph is only limited by the camera. In my case, 12mp. But, good focus and contrast/exposure is essential and white balance can affect the resolution. The biggest issue that I have had is sending the photo via e-mail. I have to re-size the pictures so that they are under 5mb. There is still an amazing amount of resolution in a compressed photo (I compress to 1.2MB)

[Jay]

Thanks will try this.