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An Electronic Method of Distributing Hand-Written Documents
Franklin L. Scamman, M.D.
Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa, United States
Our hospital's information system (HIS) is not capable of distributing hand-written or faxed-in documents. We created a stand-alone system to make the preanesthesia evaluation and other documents, such as local medical evaulations, available from all hospital workstations. The scanning station consists of a Visioneer® flatbed scanner and a networked PC running Visioneer's PaperPort® software. The scanned document is saved in Adobe® PDF format and transported to the web-based document server using the Microsoft Windows® Network protocol. The server is located in the HIS computer room, powered from the HIS uninterruptible power supply and is located behind the HIS firewall. The firewall is configured to make access from other than an on-station internet address unlikely. In addition, the server requires a user ID and a password that may be obtained either via a trust arrangement with the departmental server or from a local list on the document server. The document server uses Microsoft's Information Server® as a host and is maintained using remote-control software (pcAnywhere®). A web browser installed on all hospital workstations retrieves documents using the Adobe Acrobat® browser plug-in. Unique file names are assured by starting with the patient's hospital number and continuing with the date and order of scan for that date, the latter being provided by the PaperPort® software. The last 6 weeks of documents are kept on the home page and then the documents are archived into folders by deciles by the first 2 digits of the hospital number. Users outside of the hospital may access the hospital's information system and scanned documents via a virtual workstation using Citrix® ICA as a transport. Documents may be printed either at the hospital or remotely.

The first 21 months of use has created over 17,000 documents occupying 700 MB. The document server has not required rebooting the past 15 months.

One of the considerations of making patient information easily available is maintaining confidentiality of sensitive information. Individuals printing documents are responsible for maintaining security by shredding them, either remotely or at the hospital. Remote access to documents requires 2 gateways of security, each having different user IDs and passwords. Citrix® uses 128 bit encryption. HIPPA-required tracking of those individuals accessing patient data is facilitated by maintaining logs of users accessing the document server.

Having our HIS patient databases available remotely, including the scanned documents, has facilitated transfer of information. No longer do the residents and trainees have to locate the paper medical record to gather enough data to initiate a preanesthesia discussion with their attendings. Additional uses for the server we have found include posting Power Point® lecture slides and Quick Time® movies. Future uses of the method include scanning the hand-written anesthesia record for clinical and billing purposes.

Anesthesiology 2001; 95:A521