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Userstory 'Greifswald'

Digital patient file: Experiences of the University Medicine.

Userstory 'Greifswald', Digital patient file: Experiences of the University Medicine.The quality of the scan track is decisive.

Electronic archive and digital patient file optimize the process efficiency in hospitals and support the realization of an individual, tailor-made treatment. How important thereby the features of a scan track are, shows the example of the University Medicine Greifswald.

The healthcare provider sees itself as the North German quality leader. Under the topic „Individualized medicine“, forms the human, with its individual characteristics, the starting point for medical activities. In order to meet these requirements, it is necessary to have a total and fast supply of information.

That is why the University Medicine Greifswald decided in 2008 to switch to a digital patient file.
On the one hand the key objectives were the establishment of a consistent, uniform information infrastructure, which enables a prompt access. On the other hand the storage space of our central archive should be relieved and in order to that the high costs of a long-term archiving for paper documents were significantly reduced”, explains Grit Czerwinski, responsible for multi-project management for the division information technology.

The central archive set up its own scan track. „The know-how of our own employees is irreplaceable for us. By preparing the files before the scanning process by ourselves, we lay the foundations for an efficient scan workflow and ensure a high file quality“, explains Grit Czerwinski.

The mixed documents are challenging for the scan process. They range from very thin notepads, letters and other documents in A4 format, thru X-ray images and computer tomographies to ECG strips of 50 to 60 cm length. All these documents have to be handled reliably and quickly. „Our goal is to provide the supplied patient files at the document management system on a daily basis“, so Grit Czerwinski.
Because the retention period for patient files can be up to 30 years, a high scan quality is an essential prerequisite. „The on the documents contained information, especially very small written values or handwritten notes, have to be clearly recognizable“, emphasized Grit Czerwinski. The quality of the scanned images is furthermore decisive for the text recognition and with it also for an optimal indexing at document level.
Important for the project manager has also been a legal, replacing scan process, so that the original documents can not only disposed but also could be used as evidence in event of a dispute.

The second look is important
The in the first instance used scan systems proved to be suitable only to a limited extent in everyday practice. A not insignificant part of the documents had to be insert separately, which complicated a time-saving batch processing. „Again and again it came to down times, because of paper misfeed. These could last for up to two days, which was inacceptable for us“, told Grit Czerwinski.
With its plastic components und its plastic paper guide the scan devices haven´t been very resistant at the disinfection. The result was the frequent exchange of scan components. All of this caused increasing costs for service and maintenance. And after all the image quality didn´t meet the project requirements. Upon the recommendation of the consultancy and IT systems house eHealthOpen, the central archive installed an InoTec scanner from the SCAMAX® 4x3-series, which had been intensively tested in the daily practice.

„At first sight the unit price for the InoTec scan system seemed to be higher as for the current device. But this changed with a look at the total costs“
, knows Grit Czerwinski.

In that way the InoTec scanner makes a continuous digitalization without down times possible. Cost-intensive technician assignments are dropped; the cleaning will be done by the scan operators itself. Thereby the SCAMAX® scanner can be kept germ-free without an increased consumption of consumable parts. The 4x3-series has a glass-free paper guide at the scan area. And the parts from the paper transport, like the band system, can easily and without any impairment of the components of the device sterilized with a cloth. Furthermore the quality of the digitalized images is much higher, which had a positive effect to the OCR-detection rate and generally to the employee satisfaction while handling the digital patients file.

Replaced scanning
In the meantime a second InoTec scanner is in use at the central archive. Every day about 40 full briefcases with 500 patient files arrive at the central archive. All of them are digitalized at the same day. These are about 7.000 to 8.000 pages per system. „Today two InoTec SCAMAX® scanners do the same work as four competing devices before“, describes Grit Czerwinski the differences in productivity.

Barcode sheets assign the documents to the defined file structure. In total there are 11 registers and a cover sheet, for example: Doctor´s letter, final report, image-generating diagnosis or laboratory. This uniform structure facilitates the future recovery of single documents. By a case number, which is labeled onto the cover sheet of each patients file, the relevant patient can be assigned.
All recorded data will run through a quality review and be signed afterwards. With his signature, the scan operator confirms the accordance between the paper document and its electronical image. To provide the highest level of legal certainty, a part of the documents gets a qualified electronical signature. This, in electronic form, can replace a by law required written form on paper.

At the end of the capture process the documents come to the document management system, where the revision-proof archiving will be made. All procedure steps follow the strict requirements of the practical guide of the German Society of Medical Informatics, Biometry and Epidemiology (GMDS), task force ‚archiving of patient files’.
With the conception and realization of the procedure steps for the exchanged scanning, the University Medicine Greifswald was advised competent and comprehensive by eHealth Open.

High acceptance reached
According to the information given by Grit Czerwinski the expectations on the realization of the digital patient file have been completely fulfilled: „After we had changed the scanner infrastructure, the quality of the digital patient file has been improved and the work processes of the scan operators has been optimized.“
The high image quality of the electronic documents and the simple activation of the documents resulted in high acceptance inside the University Medicine Greifswald. Authorized employees on patient level have access to the required documents at the electronic archive via the hospital-information-system. Thus a quick access to laboratory results, computer tomographies or X-ray images is guaranteed, which facilitates the work of the doctors and improves the patient care as a whole.


University Medicine Greifswald
The origins of the hospital can be traced back to the institution of an ambulatory clinic downtown Greifswald in 1794. Today, with 926 beds and about 4.400 employees, it currently takes care about 169.000 patients, thereof are more than 36.000 stationary, per year. The University Medicine Greifswald is divided into 21 clinics and 19 institutes. It is a maximum care hospital, a university hospital and city hospital at the same time and that is why it also renders a high percentage of the services of the basic and standard care.