Total Solution Packages for Today s Small Business The Everyday Guide to Medical Data Archiving and Retrieval using Microsoft Access
Chapter 1 Introduction to Medical Data Archiving and Retrieval Data Archiving may seem a daunting task in the beginning, but the benefits include easily searchable and retrievable patient records and virtually no paper charts to deal with. To save time in the future, one must prepare in the present. Wars are won and lost in the trenches, and the battle for your office against a mountain of patient charts and paperwork is already underway. It is a war in which all physicians fight a losing battle. State Laws require that every patients records be kept for several years after they see a doctor, and minors records must be kept even longer. The result is what every doctor s office looks like -- an entire wall of patient charts with many more hidden away or stored somewhere off site. Doctors have long sought a way to minimize clutter and maximize productivity. Electronic Data Storage allows for just that an easily retrievable, easily searchable file which lasts longer than paper, is easy to manipulate and update, and takes up much less room in your office. No more wasting time and valuable resources searching for a chart, copying needed notes or insurance reports, and then re-filing it. Now, you can search for a patient s record from your desk, retrieve and update the chart, and re-file it without leaving your chair. This manual will teach you to harness these valuable resources using simple, easy-tofollow steps. Follow along on your computer as you read through these instructions, and refer to this manual as often as necessary should you need more guidance along the way. Before We Begin Two computer programs, OmniPage Pro 12 and Microsoft Access, are the principal components of the archival system. They must both be running throughout the process. First, from your computer s Start button locate the OmniPage program name or icon and left-click on it. Second, follow the same steps to locate and start the Microsoft Access program. Finally, please open the file titled Patient Database, which is located in the folder called My Documents, which should be found on the computer s desktop. Now we are ready to begin. 1
Scanning Your Documents to OmniPage A great feature of your document scanner is the automatic document feeder (ADF.) The feeder is designed to assist you in getting your documents scanned quickly and easily. But, as with anything else, there are certain preparations that need to be made in order for this part of the process to run smoothly. PRE-SCAN DOCUMENT PREPARATION CHECKLIST R R R R 20 Pages or Less No Staples No Bent Corners Fan Repeatedly Insert the pages of the chart into the scanner s automatic document feeder. If the chart is quite long, separate the pages into sections of 20 pages or less and feed each section in sequence. Make sure there are no staples in the stack and that the pages are not stuck together in any other way, such as by bent corners or in the areas where the holes were punched into the sheets. Fan the stack repeatedly before putting it in the feeder. Once the document is placed into the feeder, the computer will ask which application should do the scanning. Please choose OmniPage Pro 12. The scanning window should then come up. Scanning Your Documents Before you begin scanning your documents, ensure that the controls on the right portion of the scanning utility panel are set to 300dpi and color. No other setting should have to be changed. Though the majority of your documents contain only text, there will be some color photos as well as documents printed in color inks. To make a faithful record of the information, it is easier to leave the settings on color, even when none is present, than to change the settings on the fly. Leaving it on the higher quality setting will not noticeably affect any file attributes. The scanning process will add pages to OmniPage in the order in which they are scanned. For example, if five stacks are required for one chart, OmniPage will continue adding pages until all five stacks are scanned. Once all pages from a chart are scanned, close the scanning utility and return to the main OmniPage window. Once all the pages from the chart are finished, there should be a long line of pages in the left portion of the window, one for every page scanned. It is not important to look at the pages individually as we can assume that the scanner is doing its job every time. Nothing prevents looking at individual pages, however, as long as the document is readable, the scanner will make a faithful reproduction every time. 2
Chapter 2 Creating (and Saving) an Acrobat PDF File A great feature of an Acrobat PDF file is the ease with which it can be accessed and read on another computer. Essentially, a PDF file is like a picture. Any computer that has the Adobe Acrobat Reader (freely downloaded from Adobe.com) installed on it can view your file exactly as it was created without that computer having the same word processing or database program as the one with which the file was originally created. From the top menu bar of the OmniPage window, use your mouse and left-click on the word File. Scroll down to the word Print, and left-click on the word Image, which should appear next to the print command. Please ensure that the document is printing to the printer called Acrobat Distiller by confirming it on the name field of the printer dialogue box. Left-clicking on the Print command should close out the box. Saving Newly Created Documents The OmniPage program will then prompt you for a filename and location for your new Acrobat PDF file. Name the file using the patient s last and first name in the following manner last,first.pdf, (i.e. Douglas Johnson s file would be saved as johnson,douglas.pdf note that there is a comma between the words.) Then save the file under the Chart Scans folder found in My Documents. Over time, you will run into more and more patients with the same name. Despite repetition in the Chart Scans file, each record will be uniquely tagged in the database, and a search will still bring up only the candidates matching your search criteria, even if they have the same name. 3
Chapter 3 Updating the Database Whether you have completed scanning and saving your documents, or you are still working on them chart by chart, you should update the database frequently. This can be done either while the chart is being scanned, or after you have finished. Updating the database during the scanning process will save time and allow you to do something productive while waiting for the scanner to finish its job. The database work is fairly simple and will only take a minute or so per record. Once you do it a few times, it will be easy to repeat for every record. 1. Using your mouse, move over on the task bar at the bottom of the screen and select the window that corresponds to the file Patient Database. Click on it and the Microsoft Access window with the patient database in it will become the main window on the screen. 2. Once it has opened, you will find several fields that correspond to each patient on each line. Fill in corresponding fields with information obtained from the patient s chart. It will be readily apparent as to what information goes in what field. The final field, Chart Link, can only be done once the chart for the patient has been scanned and saved. We will discuss this in more detail in the following section. Need to Add Pictures to a Patient s File? From time to time, you will come across a chart that has pictures to be added to it. The task is easy to do and helps to keep your photos with their patients charts. We will discuss this in more detail in the following section. 4
Chapter 4 Linking the Database and Adding Pictures These next few steps are all you need to know to accomplish this part of the project. These steps are a bit time consuming, but taking the time now to create a great database will save you lots of time later in finding and retrieving the right chart with the right information. Follow along with the illustrations as we continue through each step. Linking the Database to the Scanned Chart As mentioned in the previous section, the Chart Link field can only be completed once the chart for that patient has been scanned and saved. If the file has already been saved, follow these steps to ensure a correct link and match: First, use your mouse to right-click on the empty Chart Scan field. Scroll until you reach the word Hyperlink and click on it. Find the words Edit hyperlink and double-click on them. Second, find the file to be linked by navigating to the corresponding Acrobat PDF file which was saved under the patient s name, and enter it when the program prompts you for it. 5
Linking the Database to the Scanned Chart, cont. The Chart Link field is the final step needed to finish creating an electronic file of a patient s chart. To complete this entire process, go back to the Omnipage program by finding it on the task bar at the bottom of the screen and clicking on it to maximize it. From the File menu, select New and then, NO. This will allow OmniPage to start saving a new set of chart pages when it begins scanning again, rather than add new pages at the end of the previous patient s chart. Adding Pictures to a Patient s Chart xuse a photo editor, if necessary, to obtain optimal clarity before adding your photos. The better they look now, the better they will look when printed. When you add pictures to a patients file, keep in mind that these are taking place of the original photos and may be used to make prints, send in emails, or via fax. The clearer your pictures are before you save them, the better they will look when saved and used later. The process by which pictures are added to the chart is lengthy, and, though not difficult, requires clicking through multiple windows. This section shows the entire process in illustrations to make the process simple to learn and repeat. We will assume, based on our experience with your office, that most, if not all of your patients pictures, are already on floppy disk. These next few steps will assist you in taking them from the diskette and adding them into your patients PDF file. 1. Insert the floppy disk in the computers A drive. On your computer s desktop screen, double-click on the icon titled My Computer. Once it has opened, double-click on the icon titled 3 1 2 Floppy (A:). A window will then appear showing the contents of the disk. 6
Adding Pictures, cont. 2. Open the first picture. It should open in the Microsoft Picture Viewer. At the bottom of the window, there is an icon of a printer. Click it and a wizard will start. Select all available pictures and start clicking next through the wizard. When it asks which printer to print to, select the Acrobat Distiller. Save the file by any filename and in whatever location is convenient. Finish the wizard. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. 7
Adding Pictures, cont. 3. Noting the location of the file you just saved, navigate to the chart file that you wish to add pictures to. Open the patient chart that the pictures will be added to by double-clicking the chart file in My Documents, then select Document à Insert Pages from the top menu. 4. Navigate to the picture file that was created and select it. The program will then prompt as to where in the file to add the pictures. Select After à Last and then click OK. The pictures will add at the end of the chart. Figure 2. Figure 1. Once the pictures are added, close all Acrobat windows. The picture file that was created is no longer of use and can be deleted. 8
Chapter 5 Building and Running Queries in the Database By this point in the process, the average user is probably asking the following question: What is all the work going to do for me? How will it make my life easier? This is the section where those questions will be answered. After a handful of charts have been scanned in and the database has been updated accordingly, you can start seeing your hard work pay off by querying your database. Building queries is the core of the data retreival process, but, thankfully, is pretty easy to get the hang of. Follow these steps until you feel comfortable enough to design your own queries. Building a Query 1. Queries are designed in the same place as your database entries, but from a different screen. On the main panel of the patient database in Access, click on the Queries option on the left portion of the panel. Here you will be given the option to design using a wizard, or to use design view. Using the design view gives much more control over the process, and will prove to be more versatile, but the wizard could be used if you want to. 9
Building a Query, cont. 2. Choose the option, Create Query in Design view. A box called Show Table will pop up. Add the patient information table, then click close. 3. Begin constructing the query. Every query will be different, but the process of selecting identification criteria and search criteria will be very similar for any Access query. The process, which can be applied to any database, will be outlined in the following steps. Designing a Query 1. First, add at least one field to identify each record such as last name. Adding this field to every query will make it easy to see which patients match your search criteria without opening the chart file. This may prove useful for running reports and gathering general information about a particular diagnosis. 10
Designing a Query, cont. 2. Second, add the chart link field to the query, so that once the query is finished, the charts for the patients matching the criteria can be easily viewed by clicking on the link. This will then open the chart file in Acrobat so that in-depth, patient information can be quickly retreived. 3. Third, add the field that contains the data you want to search for. For example, if you want to see a record of all patients diagnosed with pneumonia in the database, then the field in question would be the Diagnosis field. xremember, your query results will only be as good as your database entries. If you have abbreviated information in the fields, used slang, or misspelled words, those words may not be included in the query results because the database matches exact strings of letters. Did You Know? Queries can be designed to be a simple or as complicated as needed. Queries can search all fields and can be built to exclude some things and leave other things. Advanced database functions are beyond the scope of this manual, but knowing something about them can be extraordinarily helpful. Access saves all previously run queries, so that you can keep using the same ones without having to redesign one every timethat you need to use it. 11
Designing a Query, cont. 4. At least these three pieces of data must be entered to have a succesful query. Then, type your search term in the criteria line. In our case, we have chosen to search for all patients with pnuemonia. 5. Save the query by Choosing File, then Save. Name the query something that will help remind you of its function. This query is simply named, Pneumonia. Close your newly designed query and return to the main panel. 12
Designing a Query, cont. 6. Back on the main panel under the Queries option, the query that you just designed will be present. Double click it to run the query. 7. The results the pertain to your query will pop up in a seperate box, complete with a link to the patient s chart. Clicking on the link will open the chart file in Acrobat, completing the query process. Whatever you choose to do from here forward will not matter if you do not make it a habit to back up your work. Not just save it, but back it up to another media (CD-R, diskette, on-line storage systems, etc.) Keeping it on your hard drive with no backup will only lead to despair and outrage if your hard drive decides not to boot up one day. Since backup is such an important part of keeping good records, creating a backup using CD-RW discs will be discussed at length in the following section. Using CD-RW discs is a very reliable system for doing backups, and requires very little investment or expertise to do well. Do yourself a favor and don t let all of your hard work on this project go to waste take the time today, and at least once every week, to back up your work. 13
Chapter 6 Backing Up Your Patient Archive and Database The simple, undeniable fact is, machines wear down. Eventually, the computer that your archive is stored on will stop running. The sincere hope is that this happens at a time and place of your choosing, once you have migrated all your data onto a new computer, but it rarely works that way. Thus, the need for a backup system. A backup system will allow you to recover the archive in the event that your computer unexpectedly fails. There are many backup solutions on the market, but we will be using Back Up My PC, by Stomp Inc. Backing Up Your Archive and Database At least once per week, and after any significant addition has been made to the archive, it should be bacled up. The process is quick and effortless. It can be accomplished with a mere few mouse clicks. To accomplish this task, one must first start the backup program by clicking the icon on the desktop called Backup MyPC. The program will open to the following window. Select the option called Open an Existing Backup. The parameters have already been set for the job, and all that you need to do to perform the backup is to open the job that has been set up for you. 14
Backing Up Your Archive and Database, cont. Highlight the job called Patient Archive Backup and click the Open command with your mouse to open the job. All the options should be preset, but you should still verify and the proper files are being backed up. The chart scans and the patient database are the only files that explicitly need to be backed up every week. The system, however, is capable of backing up anything should you choose to make more full use of it later. Once verified, click the Start button. 15
Backing Up Your Archive and Database, cont. Once you press the Start button, the system will scan the files to be backed up. Make sure the CD-RW marked Backup01 is in the CD-RW drive. After this, the system will begin to automate and will function by itself unless a new disc needs to be put in the drive. After the system scans, it will check the CD-RW and find that find that there is already data on the disc. Whenever possible, it is best to Append to the disc rather than Overwrite it. Figure 1. Figure 2. Once the computer starts going, it will only stop to ask for new discs. The same set of CD-RW discs will be used over and over, but it is IMPERATIVE that the discs be used in the numbered order. The backup is set to only save over information on a backup disc if the information on the computer has been updated. The system relies on seeing the same CD-RW discs, IN THE SAME ORDER, *EVERY* TIME. In the beginning, the backup will only take one disc and a few minutes, as the archive grows, so too will the set of backup discs and the time it takes to perform the backup operation. The time it takes to backup, however, is a small investment compared to the many hours spend entering data and scanning charts. You will spend minutes doing the back up to protect the hours and days you spent doing the initial work. 16
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