Friday, October 3, 2008

In Search of Document Management Software

This blog is a technical discussion for people that need to make IT decisions about document management. If you don't care about IT, have never heard of a database or don't need to mange documents I suggest you go have some fun at this web page or this one.

If on the other hand, you've ever grappled with the problem of what to do with that electronic report or fax this blog's for you. Here's the problem. Not all EMR software is intended to manage masses of documents. Most are based on small databases not intended for dozens of users or masses of images (e.g. Access). Larger databases can handle scanned images and many users such as SQL Server, SQL Anywhere or Oracle. One of the main differences is how they handle errors such as when a connection is lost when updating the data. In smaller databases, an error like this can corrupt the entire database. This will become important in a minute.

The smaller document management solutions allow you to scan the document, the program then creates a file folder with an automatic name and saves the new file into that file folder. To relate the unique patient ID to the file folder the programs usually maintain a small database. If this database gets corrupted all links to the file folders are lost and there is no way to figure out which patient belongs to which file folder.

The better way to do it is to store images into a large database. Our offices' EMR is based on SQL Server. It can handle large scanned images (like x-rays and scanned documents) but the 'front end' is inadequate, matching it to TWAIN compliant machines (scanners, camera) is expensive and adding scanned images or documents to it would bloat the database.

The answer is to find a SQL Server based document management software with a TWAIN driver interface that is not intended for a massive company. Opentext and AGFA solutions are more than robust enough but too expensive for our office.

Luckily, smaller companies are starting use enterprise databases (like SQL Server) which are exponentially safer for critical data. The latest company that we're looking at is Dolphin Imaging. It started as a dental product for managing dental x-rays, pictures and scanned documents but seems to have evolved into a low cost alternative for document management. The major benefit is it handles most TWAIN devices and saves the image files to SQL Server.

I've found out the hard way that how document management software stores the images and data is far more important that what the interface looks like. I would warn everyone that before you start scanning all of your patients faxes, lab reports and requisitions into an EMR you check under the hood.

1 comment:

everdream said...

Good point. I work in a hospital (used to be in IT) where we have a huge proprietary database. I'm sure the Docs in their private practice can't afford to make the changes that bigger organizations can afford to make - and these things DO COST A LOT! I concur that Microsoft Access is simply too limited for this use. I'd suggest getting a good IT consultant to help you make this move, or at the very least, ensure the backend database is SQL or MySQL or PostgreSQL or perhaps Oracle.