Gradually Changing the Capture Process

Our client is currently scanning lab test requests at their California office. These are prepared by having a PDF417 barcode label affixed to the document, which contains the main metadata value, called the Accession Number. Accessions (i.e., lab tests) are scanned, processed by the PaperVision Capture software to recognize the Accession Number, full-text processing is performed, and then the processed data is uploaded to ImageSilo for access from any office. They would like to begin processing their EOBs and other backup documents as well, so they are included on ImageSilo.

These supporting documents physically arrive at the office at a later date than the lab results, of course. The objective is that a single search of an Accession Number on ImageSilo brings back the lab results and any relevant backup documents, if available. It is important to note that some supporting documents, notably EOBs, contain information about multiple Accessions, and therefore must be duplicated so they appear in more than one Accession search. Ideally, this duplication process will not take additional space on ImageSilo.

Currently backup documents are sent for manual scanning and indexing before processing. Hard copies are then sent for manual hand-key entry into the billing-management system. This hand-key process consists of entering at least one unique reference then hand-keying individual line-item details.

Now, you can see the duplication and labour-intensive issues here, and, as a technologist, it’s easy to make the jump straight to sophisticated forms-recognition functions auto-populating the practice management system in the background, thereby eliminating errors, reducing labour requirements and making everyone’s life a lot easier. But it’s often not so clear cut. The user is already expending the labour, and even when you can show a clear ROI, they may not be ready to make the capital investment in forms recognition software, or they may not think their staff are ready to support the new process, or there may be concern about third-party vendor cooperation or even whether the third-party applications have the capability to back-end volume data imports, and the potential cost implications of those applications, et cetera, et cetera. So we go down a different road, the available road, and we begin to gently transition the process to better, at least, if not best.

Step 1: Immediate Changes to Capture All Supporting Documentation

The first step does not significantly reduce the amount of effort currently being expended, however remember that this wasn’t the primary objective. The main goal is to bring all supporting documents onto ImageSilo, so that lab results and supporting documents can be located with a single search.

In PaperVision Capture we create a new capture Job for scanning supporting documents. This new job has similar index fields as the primary lab results scanning job, with whatever additions are required, if any. The output data will load to the same project as current lab results so all documents are in the same place. (We considered different projects and global search methods, but it’s not really practical on this job, especially with the existing search integration from the web-based practice management application.) The scanning process will differ from the current barcode-breaking mechanism to include manual document breaking (we are investigating other methods, and whether barcodes could be made efficiently at this stage; I don’t think so, but possibly). We also add the document “duplication” process during indexing using PaperVision Capture Detail Sets functionality.

PaperVision Capture Detail Sets define a collection of indexes that allow multiple sets of field data to reference a single document. This will allow the user to create X number of “duplicate” database entries (where X is based on the number of accession references required per supporting document), and where the duplicates are only database entries pointing to the same image file(s) and not physical copies of the image. With the appropriate number of duplicate entries, the user can then begin manually indexing the various accession references that are present on the scanned document. The unique reference field (EOB reference or similar) automatically carries across all documents and is not indexed manually more than once (but will need to be indexed manually each time the detail set changes). Indexed documents are submitted and uploaded to ImageSilo automatically.

And our first objective – getting all the data online and accessible – is met.

Step 2: Automating the Indexing and Merge Process

At this point we will seek to change the process so that keying of data into the practice management system occurs before scanning. In this way, all the data entry has been completed and the indexing data is available for us to run database updates.

In short, this process would allow users to scan each supporting document, index only the unique reference number, and then use database update functionality native to PaperVision Capture to create the appropriate number of items in each detail set, and populate Accession references across all of those items with the data that has already been hand-keyed once.

So, we start getting more efficient on the data-entry at this point – instead of keying into the imaging system and then re-keying into the practice management application, we’re going to hand-key from hard-copy into the practice management and reverse the population of data into the imaging system (whereas normally we would seek for an imaging system to populate the accounting system. Remember, baby steps.).

We have a few questions on this part, of course, mainly around the best point of entry for accessing the hand-keyed data. Does the commit on the data entry process immediately generate a transmission into a reference database? Or are we waiting until the actual data merge takes place to pull data from the web-based application? We’re looking at methods now and our decision will, as ever, be based on the most efficient method for users.

But we also open up a couple of other areas of potential efficiency gains. Particularly we’d like to eliminate the hand-keying in the imaging system altogether, as well as improving the document break method. So at the data entry point, can we generate a unique 2D barcode reference that applies to the supporting document and kills two birds with one stone: the barcode becomes the automatic document break and populates our unique reference field, enabling automated details sets and bulk updates of accession references. That’s the question we’ll be asking ourselves in weeks to come.

One step at a time. But the sooner we can get to at least this step, the better for the client. At which point they will be a lot more open to re-visiting the ROI on a proper forms-recognition module that eliminates all hand-keying from the process entirely. Especially considering that they are seeing those volumes rise on a weekly basis already.

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Integration and the Ratchet-X AppSpace

We’ve recently completed an integration project using Ratchet-X, the code-free integration tool from RatchetSoft. And once again it has proven to be one of the most useful applications I’ve come across. RatchetSoft claims to be able to integrate your desktop applications with anything, and after my experience with them it’s hard to argue that they wouldn’t be able to. The interface definitely requires some familiarization – you likely couldn’t come in off the street and pick up this application – but that doesn’t mean it’s difficult, just that you’ll need some guidance. But with the eminently affordable professional services options available to you from RatchetSoft and from Scanfree, you can’t go too far wrong.

Vantari Genetics, a genomics testing company based in Irvine, CA, provides lab tests for various hospitals and doctors across the United States. Vantari chose ImageSilo after a poor experience with another document management provider. Scanfree’s long time partner HSMG specializes in document management and integration projects for healthcare service providers, and brought Scanfree in to install and manage a premises-based scanning solution using PaperVision Capture. They use PaperVision Capture for processing lab results with automated uploads to ImageSilo taking place multiple times per day, for immediate access by staff at any Vantari office.

As usual, the PaperVision Capture implementation went smoothly. Using some internal databases we started generating 2D bar codes using the PDF417 format, which are applied via labels as test requests and results come in to the mailroom. Currently we’re only reading a 10-digit accession ID as the primary index value, but the PDF417 format ensures we can expand that data capture, should they feel the need to do so. They already worked with a batch mentality so it was easy enough to convert their paper-process batches to PaperVision batches. They work with relatively small data batches, submit each set of docs as it is scanned with a visual verification checking all the bar codes have read correctly (with no failures thus far, that’s after a few weeks of running high numbers of documents = not too shabby) – PaperVision processes the data, cleans up images and uploads to ImageSilo in an automated process; within 30 minutes of batch submission the data is online and accessible.

But that was only half the game for Vantari. One of Vantari’s main line-of-business applications is developed (and hosted) by Xifin, a San Diego, CA-based software company that provides a popular practice management, revenue management and billing solution for labs, radiology clinics and more. Xifin offers a series of hosted web services and portals, and Vantari use Xifin MARS, Xifin’s web-based billing solution. There were 6-8 key screens that Vantari wanted to integrate so that users could immediately access lab results when required. But as MARS is a hosted system in a shared architecture, integration options, while available, were going to prove costly if we had to get developers involved. Simple integrations should not have to cost so much. Enter Ratchet-X.

In a nutshell, Ratchet-X works at the desktop level, analysing and interpreting (nay, dissecting) the Windows desktop environment (not to mention browser windows, and, more recently, Java environments). Operating in this space gives Ratchet-X a detached sort of freedom – they call it, aptly, the AppSpace. In this space, Ratchet-X can read and analyse data and relative positioning of that data on specific screens to extract or transfer (i.e., paste) that data wherever it needs to go, incorporating scripts and API’s if required. If it sounds a bit like screen-scraping of yesteryear, you’re not a million miles off… but it’s light years beyond screen-scraping. I can’t possibly do it justice here, but suffice it to say that the level of depth and the options available to the Ratchet-X “developer”* will almost certainly fulfil their (and your) ambition to “integrate everything.” *(note: development skills are not strictly required, but an understanding of programming logic would be beneficial)

As a matter of fact, let me quickly expand on that: I used a pre-built ImageSilo integration script codenamed RX4PVE; other similar scripts exist for a variety of products in lots of different verticals. These can be used to perform simple integrations like the Xifin to ImageSilo link we created in 2 short days. But the raw product, Ratchet-X sans scripts, is so deep, and so powerful, that there’s almost no limit to where it can be applied. Scanfree’s next Ratchet-X project is already lined up: we will be integrating PeopleSoft with a workflow tool to simplify data entry for a large healthcare provider.

Frighteningly, I see huge potential uses for it in everyday AP and HR Microsoft Excel-based nightmare scenarios. You know what I mean – those spreadsheets that companies have used since spreadsheets were invented, that let them manage and manipulate data sets without having to involve IT or build complex databases. I say ‘frighteningly’ because I’m not one to encourage use of the Excel spreadsheets, but let’s face it – they’re still incredibly popular in companies of all sizes, and in that sense Ratchet-X promises more stability and consistency than a lot of other user-developed ‘solutions’ that are currently employed. And it can’t be beat for cost, so I can see a genuine value there, even if I think the spreadsheets are a nightmare.

But I digress. Working with RatchetSoft’s senior support staff, we quickly identified available integration points in the Xifin MARS browser-based interface. Using regular expressions we pinpointed the windows, frames, and data areas from which we wanted to extract the search criteria. Then we used the pre-written ImageSilo scripts to lock in our search criteria and entity/project information for each type of search. It took us a few short hours with RatchetSoft to get up to speed on the best methods to use for the Xifin portions of the integration, and we continued on our own thereafter. By the latter half of the second day we had integrated all of the relevant screens and we ready to package up our integrated solution. And this, I have to say, is incredibly slick.

I won’t go into too much detail, but the packaging process that is built into Ratchet-X allows you to collect and compile all components of the integration you just developed. Remember, no code has been written and no changes have been made to either of the integrated applications. At the end of the packaging process you are left with a self-contained EXE or MSI. You can then ask any IT person to install across as many desktops as required, or use push mechanisms to install on client machines across your network. And with RatchetSoft’s “not-concurrent” licensing mechanism, that means you can push it out to everyone and really get more bang for your buck. Contact us to learn more about that innovative licensing model.

The next time users logged into Xifin, they were greeted with the Ratchet-X ‘magic button’ (unfortunate naming, again, I know, but it is sort of magical considering the lengths you might otherwise have to go through to get two hosted products integrated). Here’s what the ImageSilo magic button looks like:

Ratchet-X Magic Button

That magic button (in the upper-right, next to the minimize button) only shows up when the user is on an integrated screen – optionally, when it shows up an audible little chirp plays to notify the user they are on an integrated screen. When the user clicks the button, the document automatically opens in a separate window. Magic.

This installation, which, all told, took 3-3.5 days including roll-out and support, has run for nearly three weeks as of this writing, and we’ve had almost no support issues. Those we did have were very minor and easily resolved (not specific to the integration but rather to unique settings on certain user desktops). And the client is absolutely over the moon – the cost-savings, both in development costs and now, with integration fully functional, in the time savings for their personnel in finding these documents, has been immense. Vantari has already approached us about their next integration project and we look forward to working on that before autumn settles in.

You’ll hear about it here first. All the best til next time.

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