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WORD version of this info WORD document Staff Tutorial
Implementation of Anesthesia Record Scanning Into Vista
Since October 2001, the Department of Anesthesia at the VA Puget Sound Health Care System (PSHCS) has been scanning the paper Anesthesia record into the VA's Computerized Patient Record System (CPRS). This was accomplished through the efforts and coordination of many different services. The following is the process PSHCS used.
1. Form a task force
A task force, with expertise from all of the areas that will be involved in the implementation, should be formed. The PSHCS Anesthesia department began discussions with the Health Information Management System (HIMS) department, Information Resource Management (IRM) service, and Clinical Application Coordinators (CAC's). The discussions helped determine the potential impact of beginning a scanning process of the Anesthesia record at the facility.
2. HIMS Department involvement
The HIMS service should work with the CAC's to determine the exact TIU note title that the scanned document will be linked to in CPRS. PSHCS chose to create a note title "Anesthesiology Intra-Operative Flowsheet" ( click here for a screen shot of the CPRS note ). A specific note title must be created for the purposes of a reference to the scanned Anesthesia record, since the actual scanned image is only viewable when logged into VISTA Imaging. Once the document is scanned into VISTA Imaging and linked to the note title for a specific date entry, an icon appears next to the note's title. This alerts anyone viewing the Note's title list in CPRS GUI, that an image is linked to that note title. These icons are only viewable in CPRS GUI and not the VISTA CPRS.
The HIMS department also gave the approval to allow a non-clinical program assistant the right to electronically sign a note in the patient's medical record. The templated note (please see CAC involvement below for more information) in CPRS would only point to the actual clinical record and would not be a note written by a program assistant. This was significant for workflow purposes within the Anesthesia department. The program assistant's electronic signature was for the purpose of completing a note to which the scanned Anesthesia Record could be attached. The HIMS department needed to approve this process since program assistants are not usually given rights to sign notes in CPRS.
3. Determine work flow for the scanning process
Another decision to be determined by the task force is determining if the Anesthesia record will be centrally or locally scanned. Centrally scanned means that once the paper Anesthesia record is completed and signed for the chart, either the original or a duplicate copy would be sent to an area where other documents are also scanned i.e. the hospital's filing room or the HIMS department. Central scanning relies on resources outside of the Anesthesia department to do the scanning. Local scanning is the process in which the Anesthesia department assumes the responsibility of scanning the document, as quickly as possible, into the patient's medical record. Puget Sound determined through discussions, that the Anesthesia department would scan a copy of the original Anesthesia record into the patient's chart. This allowed the original document to be placed into the paper chart immediately (this was a requirement by the HIMS department). The Anesthesia record used at PSHCS is a No-Carbon Required (NCR paper) 2 part form. The original is separated from its copy and placed into the patient's chart. The NCR copy is left for the OR program assistant who makes a photocopy. PSHCS determined that a photocopy, at the setting of one darker than normal on a photo copier, created a good input document for scanning, much better than scanning directly from the NCR copy. A program assistant in the Anesthesia office has the responsibility for scanning the Anesthesia record as a daily duty. Other program assistants in the Anesthesia office were cross-trained to cover during vacation or sick leave absences.
4. IRM service involvement
The IRM department was consulted to determine the correct equipment needs for the scanning process. The PSHCS Anesthesia record is a single sided document and may have more than one page for scanning. Based on the estimated daily volume of records to scan (twenty) it was determined a flat bed scanner (HP5) was fine. High daily volumes of records to be scanned might dictate the need for a high-speed sheet feeder multi-page scanner (expensive). The HIMS department and CAC's determined that the scanning process for one patient record would average 3 minutes per record. Once a program assistant is trained and comfortable with the process, the average time might be less.
The IRM department also needed to install the software to the workstation where the program assistant was to do his/her work. VISTA Imaging has two separate programs. The first is called Vista Imaging Capture Client. This is the software that allows the capture of the scanned document and allows the program assistant to select the document/note to which the image is to be linked. The second VISTA Imaging program is the View Client. It allows the viewer to see the scanned image.
5. Clinical Application Coordinator involvement
The CAC's must be contacted and involved for their knowledge related to TIU note title creation, user configuration with keys which allow a user the rights to scan documents in a patient's chart, and training personnel on the VISTA Imaging Capture Client software. The PSHCS Anesthesia department coordinated with the CAC's to arrange for a 2 hour training session for the program assistants. The CAC created the note title "Anesthesiology Intra-Operative Flowsheet" with templated text in the body of the note which reads "The attached scanned document can be viewed by opening Vista Imaging". The purpose of the templated text is to provide a helpful hint to a provider browsing the note titles list that a scanned image is available.
6. Anesthesia Department involvement
The Anesthesia department initiated the idea of scanning the Anesthesia record into the patient's chart. After determining the workflow and consulting with the different services mentioned above, a start date was selected to begin scanning.
Process for scanning the Anesthesia Record
The process for scanning a record into VISTA Imaging is as follows:
A. Sign onto CPRS GUI
B. Select the patient to whom the Anesthesia record belongs
C. Left click on the Notes tab (This can be set as the default tab for efficiency purposes).
D. For Outpatient Surgery cases, select the provider Anesthesiologist and the appropriate clinic at the top middle button on the tool bar. This is the visit encounter button. After entering the information, close this box.
E. Left click the "New Note" button in the lower left corner of the screen. A box with note titles will appear. Type the name of the Anesthesia note title that has been approved by the HIMS department and created by the CAC's. (This note title can be saved as default note title for efficiency purposes).
F. After opening the note, right click in the note and move the pointer to the option SIGN NOTE NOW.
G. Enter an electronic signature code.
H. Next, minimize CPRS GUI and find the icon for the VISTA Imaging Capture Client software.
I. Sign onto the program with an ACCESS Code and VERIFY code.
J. Select the patient for whom a note was created and signed as described above.
K. Select the Anesthesia note created in steps E, F and G.
L. Place the paper Anesthesia record in the scanner.
M. Left click the button labeled "Capture". The scanner should then start scanning the document.
N. After scanning is completed, left click the button labeled "Image OK".
*A helpful hint – Left click the button on the tool bar for Pan Window. This is to look at and assure the correct patient's note has been scanned, by looking at the addressograph in the lower left corner of the scanned document. *
O. Left click "OK" again when asked if wants to save image.
Multi Page Anesthesia Records
A. Follow steps A through K as described above.
B. Next, left click the button labeled "Scan Multiple" and left click in the check box that says Multi-Pg ADF (which means Automatic Document Feeder).
C. Proceed by placing each paper copy into the scanner and left click on the button labeled "Capture".
D. After scanning multiple pages using the process described above, left click on the button labeled "Study Complete". A box for comments will appear. PSHCS has opted to write the statement "Anesthesia Record X pages". X means however many pages were scanned for that patient's record.
Additional Helpful hints to Increase efficiency:
When initially learning to do this scanning process, our recommendation is that an inexperienced person assigned to the process of scanning, do one patient record at a time. The person should move completely through the process of opening a note, signing the note, selecting the correct patient in VISTA Imaging, scanning the Anesthesia record, and saving the record. Once the whole process is learned you will probably find it more efficient to (a) create all the notes in CPRS for the patient records you have and (b) then go to VISTA Imaging and scan in all the records for the notes created. This saves the time of bouncing back and forth from CPRS to Imaging for each patient.
Set defaults in CPRS as described above:
Default tab: Notes
Default HIMS approved note title
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