Tuesday, July 20, 2010

Automating Faxes - Turn-Around Documents

Recently a prospect presented the following scenario:

High number of facilities
Fax is the current communication method between facilities and the lab
Faxes are handled by humans at both the facilities and at the lab
How can we improve our process?

The techniques described below can be put into practice in low volume situations as well.

While the ideal would be to eliminate faxes entirely with, for example, a web site or an email-technique, or, ideally, direct application integration, these techniques all require a change on the part of the faciltiy; something that is often too hard to accomplish.

So, what can you do with faxes to improve the process through reducing labor effort and reducing errors?

Phase 1 (Fax Server)
Implement a fax server at the lab.  A fax server can send and receive faxes without a human handling the paper.

At the lab, the fax server can be configured to receive fax as electronic files based upon the number that originated the fax.  As an example, Facility A faxes from fax number A.  When the fax is received at the lab by the fax server, the fax server detects that the fax originated at fax number A and therefor places the fax file into a directory accessed by the clerk that works on faxes from facility A.  alternatively, the fax server can be configured to email the fax file to the clerk.   Variations on this theme include uploading the fax file into a workflow system that automates the routing of the fax.

At the lab, the fax server can be configured to send faxes to facilities, such as Facility A.  An easy way to do this is through a "fax printer" accessible from the Windows Print environment at each desktop.  This makes it trivial to "print" the lab results directly from the lab application and have the results, with a header page, fax out to Facility A.

Phase 2 (Workflow)
Implement case processing at the lab.  Case Processing quickly automates manual steps in a process.  As an example, the inbound fax might contain an order for a single patient to perform multiple tests or it might contain multiple patients for the same test or a combination.  Case Processing automates presenting to a human the fax and enabling that person to quickly key the correct test orders.  It then can queue up the individual test into multiple testers queues in an appropriate priority order.  When the tests are completed, the results can be matched to each of the orders, the orders assembled into a single fax, and the fax sent out to the correct facility.

Phase 3 (OCR)
Implement Optical Character Recognition at the lab to reduce the manual data entry from Phase 1 above.  In particular, OCR can detect a facility identifier, the individual patient medical record numbers (MRN), and, if the fax form has been configured effectively, it could detect which tests to perform.  In this way, the bulk of the work performed by a human in Phase 1 can be reduced.  It can't be eliminated, because OCR always has errors that need to validated, but it can significantly reduce the human effort required.

Additional techniques to improve the above include:

1. use "comb" style hand-print constraints:

Open comb fields (i.e. no line on top)
o Cells must have a U shape (otherwise they might be recognized as an "L"
o Tick marks in between characters must be of the same height but use a high mark to separate words or sections (SSN or date are good examples)

2. provide "turn-around" documents whenever possible
Turn-around documents are those that originate at the lab, sent to the facility, are adjusted by the facility, and returned.  Examples might include a "orders approval" form that lists every lab to be performed for every patient.  The key benefit of turn-around documents is that the lab has complete control of the placement of content on the form, as well as the ability to uniquely identify each page - this enables the OCR product to know what the form is exactly and then do the recognition of the text based on known locations for the content.  Besides, the facility people will have to do less work.

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