- Using E-records: Things to Consider When Planning and Implementing Image Capture Systems in Health Care Facilities.
By Catherine Sea
Whether it’s a small doctor’s office, a medium-sized clinic, or a large hospital, heavy counts of paper documents are still the norm every day. It costs these facilities immense amounts of resources to properly manage a never-ending accumulation of paper records. According to the American Hospital Association, paperwork adds at least 30 minutes to every hour of patient care provided. And according to a 2011 global survey by Deloitte Center for Health Solutions, health care consumers feel paperwork is wasteful in many countries. In the UK, 53 percent feel redundant paperwork in the system is a cause of wasted spending. In Portugal it’s 67 percent; Germany 65 percent; France 53 percent. Of the 10 countries surveyed, eight rated paperwork as the most wasted spending in their health care system. The remaining two countries rated paperwork the second most wasteful item.
The UK, France, Germany and Portugal are part of 8 of the 10 countries surveyed where patients say paperwork is the single largest wasteful item in their health care system.
Paperwork is at the heart of defocusing care providers from delivering great service to patients. It’s worse when you also consider required sharing of documentation between third party service providers. The continued explosion of paper documents in health care has grown the emergence of EMR (electronic medical record) / EHR (electronic health record) systems providers. With such systems, digitization of paper documents is proving to be vital to lowering administration costs. It’s now critical to implement an efficient document / image capture solution to effectively create and manage digital health records.
There are clear time and cost savings benefits in using an image capture solution. But, there are various things to consider when choosing a solution. To start, one needs to compare and contrast the advantages of building an in-house solution or using an off-the-shelf solution. Relevant staff and IT management need to understand the technical requirements involved with either type of solution.
In-House vs. Off-the-Shelf Solutions
There are quite a number of professional off-the-shelf EHR options on the market to serve the needs of health care practices of all sizes. Most commercial EHR systems are designed for a broad base of practitioners and may not suit specific needs of all health care providers. For this reason one may consider developing their own image capture solution - to tailor it to specific requirements for that practice. While an in-house option allows full customization, the time spent and the research and development costs might be too high. It’s important to evaluate the man-hours and manpower needed to implement a full in-house solution. Remember this includes throughout the lifecycle of the application: planning, development, implementation, changes and support during use.
There are many technical considerations, starting with the device types to be used. You’ll need to start with a feature list for an in-house image capture solution. In doing so, an important step is determining which types of images you need to capture. You may need to support JPEG, BMP, PDF or more. Also, don’t forget the operating system (OS) environment – do you need to support Windows and/or Mac or more? Regarding device types, you’ll need to evaluate if it’s just scanners or if webcams might be important. Webcams can be vital. For example, a patient at home could snap a picture of their ID with a webcam to process into your application. Then the types of application programming interfaces (API) to be supported can be sorted out. An API is necessary to enable software component interactions with each other. This includes how it accesses a database or specific hardware.
This is one of probably hundreds of lines of code required to build an image capture app from scratch:
For example, you could use the TWAIN standard to interact with scanners and capture documents like patient records, prescriptions, etc. TWAIN includes support for devices such as scanners and digital cameras. It is supported in operating systems such as Microsoft Windows, Mac OS X and Linux. TWAIN is designed primarily for C/C++ development. You might instead opt for the WIA standard. WIA is a Microsoft driver model and API for Microsoft Windows, which has been around since the days of Windows Me. In Windows Me, it enabled graphics software to communicate with imaging hardware such as scanners, digital cameras and digital video-equipment. Since that release in 2000, Microsoft has steadily added features, including OLE integration. However, since the release of Windows Vista, WIA has been more targeted towards scanners.
Another option is DirectShow to interact with webcams to capture photos and store in your central database. DirectShow is a multimedia framework and API produced by Microsoft. It can be used to perform various operations with media files or media streams. DirectShow is a replacement for Video for Windows (VFW), also known as Video Compressions Manager (VCM). Most webcams, including FireWire cameras, support the main interfaces of DirectShow. But, you should note that USB Video Class (UVC) cameras have the most market share. After determining the APIs to use, you then have to choose whether to create the application from scratch – to create all the code yourself. Or, you could instead take advantage of third party pre-built components which save a lot of time since you don’t need to learn the intricacies of coding from scratch, related standards and APIs to implement.
System Integration and Ease of Use
Another important aspect to consider is the integration of your image capture solution into existing workflows and systems. It is necessary to bear in mind that the image capture module will be implemented as one part of your whole workflow. It will facilitate the daily paperwork load of your health care practice. So the technology used for the image capture module must be compatible, easy to use, and easy to integrate with any existing systems.
For example, you’ll need to verify if desktop access is enough for your users. Or would users benefit from a web client to be able to check records from any computer containing a browser and network access? Ultimately, to ensure an increase in productivity and cost savings, you need to ensure simplicity in a user’s efforts to scan documents or capture images to your system. You should consider a survey of users of varying types to learn their requirements and feedback. This will avoid the mistake of producing a powerful but cumbersome system. It will also help ensure user buy-in that is critical to adoption by all.
If you decide to choose an off-the-shelf EHR solution, there are several things to consider too. The first thing is how easy it is to customize for your needs. Remember that most EHR solutions are designed for generic purposes. So it’s important for you to confirm whether it’s possible to customize the solution to meet your unique requirements. It’s equally important to evaluate the work/costs involved in such customizations. While not as time-consuming as coding everything from scratch, implementing an EHR is still a rather big project. You are likely to encounter unexpected obstacles before, during and after the implementation. So it is vital that you choose a vendor with good technical support for all phases of the EHR's lifecycle.
If you’re planning to do it in-house, take advantage of online forums such as www.twain.org. The TWAIN forum, Stack Overflow, and MSDN provide a plethora of online technical information. If you want to take advantage of a third party imaging software development kit (SDK), search online for “image capture SDK.” These pre-built solutions can turn months or year-long projects into days. An image capture SDK has some up-front costs but they do significantly save on time and other costs that could amount to more than an SDK. However, also research SDKs to ensure they deliver the features, customization and technical support levels you require. Whichever way you go, there is plenty of information available online. No matter the route you take, you will be on a path to reduce paperwork time and cost burdens by leveraging advanced image acquisition applications that are now must-haves in health care.
Catherine Sea is the customer service manager for Dynamsoft. She regularly blogs to provide tutorials on TWAIN, image capture application, and version control best practices. She has also been a consultant providing programming solutions to developers of document management applications.