Saturday, November 03, 2007

Medical Records Scanner

On my current temp assignment I scan paper medical records into a computer database at Springfield Clinic.

Yesterday our manager gave us a pep talk, part of which involved telling us to strive to increase the number of records we scan each day. She didn't mention making improvements along the entire chain of communication. She may not have been aware that there are times when we run out of documents to scan and must scrounge to find work, and other problems.

To me, and perhaps other scanning clerks, it appeared that we alone were responsible for improving the rate at which we scan medical records. It may not be the case, but it didn't improve my perception of her.

Each person assigned the task of scanning medical records is required to count the number of images scanned and tally their totals at the end of each day.

The purpose was not disclosed, but was easily construed as a method by which to compare the productivity of persons assigned to scan the records.

The objective as proposed initially has many problems that will either skew the results, or will leave an individual or group vulnerable to retribution or termination of their job for something that was not their fault:

A. Sheets that requires the user to switch resolution and color modes on the scanner.
B. Re-scanning sheets after adjustments are made.
C. Sheets that are missing medical record number (MRN), date of birth (DOB), or other information for verification.
D. Sheets missing the MRN, requiring the extra steps to lookup the name and date of birth.
E. Scanner hangs with an hour-glass icon for several seconds.
F. The time it takes to remove staples, or rescan documents having hidden staples that jam the scanner or tear the sheet.
G. Unfolding or unrolling paper to accommodate the scanner.
H. Sheets requiring the use of the scanner bed instead of the duplex feed-through scanner.
I. Incorrect MRN.
J. Adjusting the contrast and sharpness of the image after scanning.
K. Sheets from separate records stapled together.
L. The interpretation of obscure hand writing.
M. Employees working against one-another by hoarding work that sabotages the statistics of other employees, making them feel vulnerable to termination or unwarranted discipline, thereby creating a hostile work environment.
N. Employees can be targeted with work that artificially lowers their statistics.

The normal process is as follows:
1. The employee picks up a sheet to be scanned.
2. The employee must find the MRN on the sheet.
3. The employee then types the MRN into the computer and calls up the appropriate record.
4. The sheet is compared to the computer’s record by cross-referencing the MRN, name and DOB.
5. The scanner is adjusted or not depending on the quality of the sheet.
6. The sheet is placed on the scanner.
7. The appropriate folder is selected on the computer
8. The scan icon is located on the menu and is selected.
9. The document is scanned.
10. The employee checks the quality of the image scanned into the computer.
11. The image is assigned a name according the department from which it came.

Some employees are given stacks of sheets organized so one can scan twenty or thirty sheets at a time for one medical record; in other situations one must repeat steps 1 through 11 for each individual sheet, or for only up to four sheets at most. The average likelihood that one would encounter one or more of incidents A through L is also statistically higher for those who must lookup records more frequently when encountering incident D.

This process seems completely unfair in judging those who scan, unless you are acutely aware of the kinds of records which are scanned. One must also be aware of the kinds of malicious behavior that can undermine the productivity of those who scan. For example, one who consistently is given sheets with the MRN clearly written, one day received a stack with no MRN, resulting in additional labor with incident D inserted after step 2.

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