November 2010

Paper Into PACS
By Dan Harvey
Radiology Today
Vol. 11 No. 11 P. 20

Filmless doesn’t mean paperless, but facilities are seeking IT applications to approach that objective.

Converting paper documents into a format acceptable to store in a PACS is a widespread need. Imaging facilities use several approaches to solve this common problem, including using DICOM, RIS, or EMR document management.

“For the long term, I believe, the last should be the best,” says Herman Oosterwijk, president of OTech Inc, a healthcare technology company that focuses on training and consultation related to PACS and DICOM. “For the short term, DICOM and RIS [are effective].”

The problem varies depending on the institution and its method of paper management, says Dennis Forgione, regional sales director for Etiam, a French-based enterprise that develops systems to bring paper into the digital imaging and records management environment.

“Large academic settings have mostly moved away from paper in their image management workflow, but many other facilities find themselves saddled with workflow problems,” Forgione says. “These can arise when the scenario involves placing data on a copy machine, like a patient’s driver’s license, and then printing it out. Other facilities are a bit more sophisticated; they use electronic readers to place information directly into the EMR.”

Etiam seeks to offer appropriate solutions to facilities with different needs and abilities. Its customers run the gamut from stand-alone imaging centers to university hospitals and major healthcare systems.

“We service anyone that depends upon PACS with a wide variety of solutions to common imaging network problems,” Forgione says. “As opposed to many of our competitors, we place a high value on open standards, and all of our products strictly adhere to open standards used in imaging like DICOM, IHE [Integrating the Healthcare Enterprise], and HL7 [Health Level Seven International].”

Print to PACS
Etiam’s solutions approach the paper conversion several ways. Its Print-In product is a virtual printer that sends documents directly into PACS. Installed on a computer that runs Windows, Print-In enables easy document importation.

Forgione offers an example: “Say that you are in Microsoft Word, and you have a document that you need to attach to a patient’s study in PACS. You could simply go to the print function and select the Etiam printer, which allows you to query your PACS for the patient’s study that you want to attach the document to. It then allows the user to do some patient data reconciliation, and you would hit ‘print’ and Print-In transforms that into a DICOM-useable format, sends the document directly to PACS, and automatically attaches it to the patient record.”

He provides a specific case that serves as a representative success story: The Guilloz Imaging Department at Nancy University Hospital. The department conducts osteoarticular imaging studies and interventional radiological services at this institution, which is located in the Lorraine region of France. The document and imaging importation into patient records led to wasted time. PACS administrator Nicolas Labonne regularly integrates documents into PACS for distribution and archiving within the institution. Specifically, he handles nuclear medicine reports, digital photographs, and specialized imaging. He says with the technology, it takes only a few seconds to import data when it previously took several minutes to perform the same importation tasks on workstations. Minutes add up to hours, and hours translate into wasted time and money.

When a document is available in only a paper format, Etiam’s DICOM Izer product offers a solution. “Often, the only thing people have is the actual paper in their hand. To get that into PACS, you need to digitize the paper document. You’ll need a standard office scanner, and you can connect that scanner with our DICOM Izer product,” says Forgione.

DICOM Izer allows facilities to capture and connect data—not just paper but also non-DICOM images and videos—into PACS and EMRs for digital storage. “The DICOM Izer receives digitized output off any standard scanner and then accomplishes the same process. Users query PACS for the patient study that they need to attach the paper to. The product turns the digitized file into DICOM format and attaches it to the patient’s study in PACS.”

In this way, DICOM Izer, like Print-In, facilitates communication by enabling information to be subsequently and easily disseminated where necessary. The technology integrates paper documents and forms using desktop scanners as well as digital images files (eg, JPEG, GIF, TIF) from digital cameras and radiology films and digital motion videos. HIPAA compliant, the technology helps medical facilities attach greater traceability to patient data and increases safety.

Standards Based
Eagan, Minn.-based Sorna Corporation has also developed innovations that facilitate document and image conversion and, in turn, easier information dissemination. The company designed its products to reduce costs, increase productivity, and adhere to DICOM and IHE standards.

Sorna’s core product is the Reviewer software suite, which it developed to address a specific medical industry need (eg, importing CDs into PACS, burning a CD for sharing, accessing images). But as far as document conversion, the R-Scan and the 2DICOM editions are the most appropriate solutions, according to Cyrus Samari, Sorna’s vice president of sales and marketing.

The R-Scan, which is shorthand for rapid scanning, easily scans paper documents and then stores them in digital fashion. “The software works with any TWAIN scanner, which means just about everything available on the market,” says Samari. “Essentially, you simply scan paper to place it into PACS.”

The software automatically creates DICOM documents, organizes and unifies records, and adds them to the appropriate existing patient study contained in PACS. “The most important thing you do when you scan a document is to tell the system which study it will attach to,” Samari says. “That study could already reside in PACS, so you do not have to create a new study to attach the paper to. Our software allows users to query the PACS, select the study, click New Series, and start scanning. If they have to generate a new study, they can select it from the worklist server or simply add patient and study information manually.”

Sorna built on this base with the Reviewer 2DICOM, adding a Drag & Drop DICOMization functionality to the R-Scan technology. This means document files and images can be dragged and dropped into a window for immediate DICOMization. Ultimately, this functionality eliminates the need to have an application installed when printing to DICOMize.

“Traditionally, users have needed more than one application, and these could come from different vendors,” says Samari. “With 2DICOM, everything is part of one product and support comes from one vendor. In the same window, you can scan paper into one series, add a second one to Drag & Drop images, and add a third to Drag & Drop Office documents. Finally, with a single click, you add all three series to the study.”

Drag & Drop DICOMization eliminates the need for installing other applications. “For conversion of a Word document into DICOM for storage, people who use the print functionality must have Word because they need a program to interpret the print so that you can take the output from the print and create a DICOM object,” explains Samari. “This means additional costs and IT support as well as the potential for the added Word document to be modified without anyone’s knowledge. But 2DICOM eliminates that possibility at the same time that it lowers costs and decreases maintenance.”

The 2DICOM software provides the ability to store the original document in addition to the DICOM copy. “That is critical,” Samari says. “It’s one thing to have an image of a Word document. However, such documents carry a lot more metadata information, such as the author and the created, modified, and accessed date and time. Someone might need to see what the original document looked like and what it reported. With our system, they have that option. You have both a viewable image as well as the original document.”

The R-Scan and the 2DICOM both provide consistency across an enterprise, a phrase that forms the company’s credo. With the Reviewer products, whatever tasks the users perform—scanning and importing paper documents, DICOMizing image formats, importing or burning CDs, or a host of other tasks—everything necessary is included in the same application.

“From an administrative point of view, particularly as this relates to radiology departments, there is only a single company to work with, a single base code, and a single product,” says Samari. “This makes it so much easier to support internal staff, get support from the vendor and, on the back end, making referring physicians happier, as they get a consistent viewer they can utilize.”

Crossing Business Sectors
Another player in this market segment is ABBYY, an international organization with U.S. operations located in Milpitas, Calif. The name may be unfamiliar to some medical professionals, as the company made its name by serving the government, financial services, insurance, and transportation sectors, among others, but it found its technology readily translatable into the medical arena.

“For healthcare customers, we can help them convert paper-based documents that become exportable into any system they have deployed in their enterprise,” says Julia Levites, product marketing manager for ABBYY USA.

Among the management and capture solutions that serve its medical customers, ABBYY offers the FineReader, an optical character recognition software that provides text recognition and enables creation of electronic files that can be searched and edited. FineReader can be used with paper documents, PDFs, and digitized photographs.

The company also offers the PDF Transformer 3.0, an intuitive tool that enables rapid conversion of PDF documents into formats easily edited while simultaneously saving the original layout. Other products include the Recognition Server 2.0, which, as the name implies, is a server-based solution. Designed for mid- to high-volume document processing across large departments and enterprises, it’s deployable as both a stand-alone program and as part of a third-party PACS.

“Recognition is scalable and server based and, as such, can be expanded to meet all end user’s needs,” says Levites. “Fully automated, Recognition increases the efficiency of the entire system.”

But ABBYY’s best achievement in this area may be the FlexiCapture 9.0, a scalable data capture and document processing system that provides a single entry point. “It easily and readily converts large volumes of documents into useable data,” Levites says.

— Dan Harvey is a freelance writer based in Wilmington, Del. He is a frequent contributor to Radiology Today.