SynapseDirect

Automating OCR

Graham — Sun, 11 Nov 2007 05:53:00 GMT

OCR, or optical character recognition, is a process whereby a paper document, or fax, is turned back into a near digital representation of the original. This allows data to be extracted from source, and possibly inserted into the EMR as discrete data. Typically though the process of OCR requires the user to select fields to scan, to check and correct the text, and then add it to the correct patient.

Synapse has a new optional utility that automates much of this by automatically OCR any documents of type TIFF or PDF, and associating them with the scanned image. If the image is of sufficiently high quality, it may be possible to take results from the OCR and then inject them into the database. You might want to check them first though to make sure that the accuracy is good enough.

In the first run, it took about 12 hours to automatically OCR several thousand of my own scans. Thereafter it sits waiting for more scans to arrive. Because the processing is done as a web service, there is very little CPU usage on the server.

We may expand this facility to automatically scan patient intake forms and enter patients into Synapse based upon these forms. Note that OCR web services can be purchased for about $250 - $300 per year, and that does not include any integration with Synapse. Our price will be about a third of this

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Synapse Web Portal Server now available

Graham — Sun, 28 Oct 2007 03:05:00 GMT

The Synapse web portal server is now available for download and testing. This is a high performance web server that runs similar to Apache in performance, but is only 800kbs in size and unlike the latter, is close to zero-administration. It is also immune to most of the vulnerabilities seen with Apache.

Although it can serve ordinary static HTML pages, it primarily serves up RSP or REBOL server pages to dynamically create web pages based upon patient data etc.

A demo of the port server is available, and you can use the guest userid with a passphrase of 1234. If you get certificate warnings, then just accept the certificate to avoid seeing them in future.

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New users downloading our software

Graham — Sat, 20 Oct 2007 22:43:00 GMT

To download any software on this site, and to read the forum messages, you must first be registered, and logged in.

To create your free account .. use the join link at the top right of all the screens and register.

If you experience problems registering, then please leave feedback so that we can fix it for you. We can then also provide alternative download links.

Note that you must use a real and active email address to register as the activation link will be emailed to the email address that you provide. This is to prevent users from spamming our forums. Be sure to check your spam folder if you don't receive confirmation soon, or, if you have a whitelisting system, allow email from the synapsedirect.com domain through.

Thank you.

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Demo server has latest updates

Graham — Tue, 21 Aug 2007 22:00:00 GMT

The demo server has now been updated so that it will produce PDFs if that option is chosen from the client.

The default templates have been altered by guests and will be restored soon.

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TEPR 2007

Graham — Mon, 21 May 2007 23:50:00 GMT

TEPR 2007 (the annual Towards the Electronic Patient Record show ) is now in progress, and Schiller, a world leader in manufacturing medical monitoring equipment will be demonstrating Synapse EMR's bidirectional interface with their PC based software.

Eddie Hernandez, IT Products Specialist for Schiller America, will demonstrate how an EKG, and other examinations, can be requested from Synapse EMR, and how the result can be imported back into the patient record.

Founded in 1974, SCHILLER is a leading international manufacturer and supplier of computer based Electrocardiographs, Spirometers, Patient Monitors and External Defibrillators, located in Baar, Switzerland near to Zurich. SCHILLER has inspired confidence in Physicians for almost 30 years, providing quality products and leading edge technology. This passion for success has propelled SCHILLER to the worldwide market leader in the Cardiac Diagnostic Physician based markets.

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New Web Host

Graham — Sat, 21 Apr 2007 23:13:00 GMT

Synapsedirect.com is moving to a new web host to cope with increased traffic demands.

This means that the demo Synapse server is currently off line.

Thanks for your patience.

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Template Updates

Graham — Sun, 11 Feb 2007 03:55:00 GMT

The template language has been updated to allow users to include patient specific variables, and the ability to insert numerical data into the patient's results. You can also specify fields that are the result of a calculation based upon the data in the other fields.

You can read about these new features in our wiki

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Fax Server Integration

Graham — Sun, 28 Jan 2007 18:30:00 GMT

For the busy medical office, the fax is an important source of incoming paper medical records, and an outgoing delivery mechanism for prescriptions and so forth. Faxes need to be read, annotated and returned, or stored in the appropriate electronic chart - preferably without the intermediate generation of paper.

Our recent beta releases provide a way for Synapse Express users to fax seamlessly from the prescription writer, and consult preview with the installation of the client version of Snappyfax ($19.99) on the server.

For our premium and hosted users, we can offer Hylafax, an enterprise class fax server. Hylafax is able to cope with multiple fax lines, and process 1000s of faxes per day.

When this has been setup, premium and hosted users will have the ability to:

Automated OCR of incoming faxes which are then emailed to a designated person
For a multiple provider office, it may be feasible to attempt to route the email to the appropriate user by "reading" the fax cover page
Incoming faxes are also automatically injected into the Synapse EMR database for review, to then be forwarded to the inbox of the appropriate staff member. The OCR'd contents of the fax are placed into the metadata.
With appropriate windows software, incoming faxes can be annotated, and faxed back to the sender
Prescriptions and consults can be faxed from any client, even if the client is remotely connected some 1000s of miles away
Junk faxes can be deleted, and numbers blocked
Incoming faxes can also be optionally printed automatically if received from particular fax addresses

Premium and hosted users should contact us for further information, or installation.

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Linux ports

Graham — Mon, 04 Dec 2006 09:16:00 GMT

Some of our users have asked us about the possibility of porting Synapse EMR to Linux. Since Synapse EMR is written in Rebol, the application is essentially platform neutral. There are some features quite specific to Windows such as the Skype, Paperport, and scanning interfaces ... but without those, it should be quite feasible given enough interest.

The Synapse Server port would require moving to a different database .. likely to be Postgresql instead of Firebird as there is no suitable obdc interface. We would look at doing this after we have completed the Linux Synapse EMR Client port.

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Health Maintenance Guidelines

Graham — Sun, 05 Nov 2006 07:50:00 GMT

Build 194 released today marks the start of health maintenance guidelines (HMG) functionality.

Along with many other user defined features of Synapse EMR, the HMGs are defined using what is called a dialect, or domain specific language. The initial definition for this is described in this posting. As we implement more HMGs, it is likely the language will expand to cope with the various possibilities.

Currently the HMGs are hard coded as part of Synapse EMR, but we expect to allow users to define their own once we have finalised the language.

Here's a couple of examples:

{medication methotrexate loinc [ "6690-2" ] period lessthan 1 month}

which means that any patient taking methotrexate needs to have a WBC ( loinc code of 6690-2 ) every month.

{Age greaterthan 49 Result FOB period lessthan 1 year}

and this means that patients older than 49 need to have a fecal occult blood test yearly recorded in Synapse EMR.

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Chickenscripts

Graham — Fri, 27 Oct 2006 07:19:00 GMT

This blog will be used to add some scripts that you can use with Synapse EMR.

Here's a script that you can use on the http://127.0.0.1:8001/cgi-bin/searchprovider.html page that appears when you click on the Firefox icon on the provider screen ( 193 beta-14 )

It takes the provider address and brings up the Yahoo map for Canada. Change the pick("Canada"); to pick("United States"); if you want to search in the USA. You can then print out the map and hand it to the patient.

// This chickenscript grabs the address details
// and brings up the appropriate map

try { street = find(/Number&Street: ([\S\s]+)/).groups[1]; }
catch(e) {
	street = '';  // this is two single quotes
}
try { city = find(/City&State: ([\S\s]+)/).groups[1]; }
catch(e) {
	city = '';
}

with(openTab('http://maps.yahoo.com/', true)) {
	enter("Address",street);
	enter("City",city);
	pick("Canada");
	click("Get Map");
}

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Synapse and Web Services

Graham — Wed, 25 Oct 2006 19:24:00 GMT

The World Wide Web has in recent years become a major and reliable delivery mechanism for a number of useful services. However, accessing those services can be a major headache as more often than not they are designed to be used by web browsers only. If you want to automate things such as using the Google api to implement your own search functions, you need to obtain your own developer's license .. and of course you need to know how to program.

A case in point. In New Zealand, we recently underwent a nationwide change in Zip codes, and it is now deemed necessary to incorporate the correct zip code as otherwise your mail will be delayed. The Post Office does supply a web lookup form to get the new zip codes, but you have to fill their form in with the number, street, town and city all in different fields. For 10,000 patients, this could become a little tedious.

Now the usual way to automate this is to look at the underlying HTML of the form, look at the form method, the form variables etc, and then write a script to automate populating the form with our data. We can do this, but the script has to be hard coded into Synapse, and this is not good. If the form changes, we have to recompile Synapse EMR to accommodate the change. And say, a user wants to use this data to go to some online white pages to check telephone numbers instead. They can't.

But there is now a solution, at least if you are using Firefox! Chickenfoot is a Firefox extension from some nice guys at MIT that allows you to control the browser using scripts. They give demo scripts for showing how to rearrange web pages, alter web pages by adding new buttons ( eg. adding a specific search button to google's search page ) and so forth. These scripts can be setup as triggers so that if you go to a specific web page, then the script is automatically run.

So, how does this help with the checking of 10,000 users and their Zip codes? Easy! We create a button on the patient details page. This generates a local web page with the address details. The chickenfoot script is automatically triggered, the address details are grabbed from our local web page, firefox is told to browse to the web page, fill it in, and then press the search button. Up then pops the new page with the patient's new zip code details.

Now since the chickenfoot script is local, and hosted in the browser, the user can write their own script to do a telephone search instead on their local whitepages directory. Neat!

How hard is chickenfoot? Not too hard, and you should be able to modify existing scripts to do what you need.

Here's my chickenfoot script that does the zip code search:

number = find(/Number: ([\w\s]+)/).groups[1];
street = find(/Street: ([\w\s]+)/).groups[1];
suburb = find(/Suburb: ([\w\s]+)/).groups[1];
city = find(/City: ([\w\s]+)/).groups[1];

with(openTab('http://www.nzpost.co.nz/Cultures/en-NZ/OnlineTools/PostCodeFinder/', true)) {
	enter("Number",number)
	enter("Street Name",street)
	enter("Suburb",suburb)
	enter("City",city)
	click("SubmitAddressSearchImageButton")
}

What this means is that we can provide you with a way to search diagnoses, drugs etc on your favourite websites even if they are subscription based, and without the need for us to code these scripts within Synapse EMR. So, if you use Update.com or other subscription services, we can provide the local web page which your own script then takes you to the relevant search page there, fills it in, and brings up the required data.

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An EMR that pays you??

Graham — Thu, 12 Oct 2006 10:58:00 GMT

Personal health records are a growing phenomenon where users take some control over their own health by maintaining copies of their own health records by amalgamating reports from all their different providers. Here's a link about PHRs from the American Health Information Management Association.

However, the flaw with PHRs is that the patient has to maintain the information themselves. They may ask for copies of their medical records, but they then have to transcribe them to store them in the PHR. Some PHR operators will allow users to fax in a record that is then stored in their PHR. All very messy. And very asynchronous. And prone to many factual errors. Why is the patient attempting to replicate the role of their FP in coordinating their medical care?

A much better way to have a PHR is via a portal. This is known as a tethered PHR... because it is primarily operated by a health provider.

Now, if a family practitioner were to use SynapseDirect.com to host their EMR at a cost of $1200 per annum, and say they had 2000 patients, of whom 50% wished to take advantage of the portal/PHR at $10 pa, that leaves a gross profit before tax of $8800 for the physician hosting with SynapseDirect!

How many other EMRs pay you ???

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Custom Forms

Graham — Thu, 21 Sep 2006 11:57:00 GMT

Some users have expressed a wish for some way to turn existing forms ( PDF etc) into forms that can be used within Synapse-EMR, and then be printed, and possibly be saved. One reason that this might be required is if the institution who's form it is, refuses to accept any other forms other than their own.

We will therefore offer a custom service to take an existing PDF form, and turn this into a Synapse form. This may not necessarily that closely resemble the original form on screen, but when printed, will be almost indistinguishable from the original. The onscreen form will be prepopulated with any relevant data from demographics and so forth, and will allow entry of further data as required by that form. The final PDF can be saved like any other file as part of the patient's record.

This process will involve some custom programming, and will be chargeable at US$195 per page. We reserve the right to decline any requests to turn any particular PDF into a form.

If the same exact form is required by other users, the fee will reduce to US$50 per page, and this will be credited back to the original commissioning customer to a maximum of US$195 per page. This means that the original commissioning customer may end up paying nothing for the form! All payments and credits will be thru Paypal.

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One button drug interaction checking

Graham — Wed, 20 Sep 2006 10:02:00 GMT

Server 0.0.63 and Client Build 189 support easy online drug interaction checking. All existing current drugs, and any drug that you have sitting in the field waiting to be added to this list of drugs, are checked against the drug interactions on drugdigest.org. Since the drug names that you may use may not be exactly the same as those listed on drugdigest.org, you are presented with a list of choices. Any such choice is then remembered the next time this drug is found in a current list. Your browser then takes you to the results.

Note that there is a slight delay the first time for each session of Synapse-EMR you use this function as the data is first downloaded from the drugdigest website.

This client build now also searches macro titles as well as macro bodies when doing a search, and has a preference for default ethnicity.

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Portal Messaging

Graham — Sun, 17 Sep 2006 13:25:00 GMT

Server 0.0.62, and Client build 187 now allow portal messaging. Patients using the client can login to the portal and send/receive messages in their "Patients/Messages" tab.

Staff can see these messages in their "Inbox/Messages" tab, create new messages and reply to existing messages.

It is planned to allow staff to send attachments and voice messages to patients. This attachment could be any file, or it could be a scanned file that is already within Synapse EMR.

Currently emails are not sent to the patient to inform them of a new message, but this will be done once we are satisfied that there are no problems.

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Portal Client Available!

Graham — Mon, 11 Sep 2006 12:11:00 GMT

It seems that the development time for an early functional portal client was less than imagined. The new client build 185 turns into a portal client when using the credentials associated with a patient.

By default, the portal is enabled for all users. There is a new button on the server control panel that disables this for all patients. Use this once only. Thereafter any new patients will be added as disabled.

To enable a patient as a portal user, enable the "active" check box on the Patients/Details/Personal tab, and save the update.

The patient who logs in is able to see their details, demographics, results, diagnoses, allergies, procedures, ticklers, and plot some results. They are not allowed to change anything yet.

Subsequent versions of the portal client will enable secure messaging etc.

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New builds and the Portal

Graham — Sat, 09 Sep 2006 23:49:00 GMT

We have new builds for both the server ( 0.0.60 ) and client ( 184 ) now available for download, and upgrade. These address some minor issues as detailed in their descriptions.

We are now starting work on building a portal client that can be used by your patients. We expect that the following functionality may become available

see current medications and allergies, but can not change
see demographics but can not change
see diagnoses but can not change
see results and can print/plot
can add some home observations such as BP, BS, steps, weight, PEFR
see selected notes, or perhaps all their notes
see appointments and request a reschedule, or request an appointment
send and receive secure messages
view their account and pay online ( when billing integration is completed )

A definite timeframe is not available but it could be that a client is ready within a few days to a month. We are not talking months!

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Demo server update

Graham — Tue, 05 Sep 2006 22:43:00 GMT

The demo server at www.synapsedirect.com:8011 has now been updated to version 0.0.59. This means that no client below the current version of 183 will be able to make a successful connection. This was done to implement user defined security restrictions, and to secure remote transcription.

So, if you wish to use the demo server, you must upgrade your clients to 183 or higher.

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Distributed Dictation

Graham — Sun, 03 Sep 2006 07:55:00 GMT

New server 0.0.57 and client build 182 implements distributed dictation for our hosted users, and for Synapse EMR Premium users.

How does it work?

Imagine that you are running behind with a back log of patients outside in the waiting room. One patient with complex medical problems has put you behind, and you can't keep up with your documentation. Now instead of dropping back to paper as some people desparate enough might do, you can now dictate inside Synapse EMR. The dictation is then saved back to the Synapse Server with a timestamp, and can be played back from any client on the network.

If you have your own transcriptionists in your clinic, they can start transcribing your dictation as soon as you have finished the dictation. No worries about damaged tapes, or tapes erased in error. The dictation files are stored on the server permanently and can be recalled at any time.

And if you wish to outsource the transcribing, we plan to build a special client just for that purpose.

Speech is recorded as 8 bit monaural sound in MP3 format using variable and low bit rates to keep the size down. So, for instance, a 7 minute recording takes up only 850kbs. However, this is still quite clear and suitable for transcription purposes.

If you are a self hosted user of Synapse EMR Express, consider upgrading to Synapse EMR Premium edition. Contact us for further information.

A video of how this feature works is available in the training videos from the top menu.

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New videos

Graham — Mon, 21 Aug 2006 17:56:00 GMT

We will be creating new videos to show you how to do common tasks within the Synapse EMR client. A few rough and ready ones have already been done http://www.synapsedirect.com/files/5/user_guides/default.aspx and in the interests of expediency, they are currently unnarrated. As we get more free time, we will refine these and add appropriate voice overs.

If you need to be shown how to do a particular task, please indicate in the forums.

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Direct PostScript Support ( all must read )

Graham — Sun, 13 Aug 2006 11:55:00 GMT

Build 177 of the Synapse EMR client now implements direct PostScript support for printing letters, requests, and charts. If you don't have a PostScript printer - read on! If you don't even know what a PostScript printer is, read here.

What is direct PostScript?
Direct PostScript is when PostScript print commands are sent directly to the PostScript printer, which is either attached directly to the PC, or on a print server on the local network. It differs from printing to a PostScript printer in Windows using the printer drivers as it bypasses the Windows printing system. This means that the target printer, if on the network, does not need to be installed as a printer. The advantage of this is increased speed.

Aren't PostScript Printers More Expensive?
This is usually true because the printer manufacturer have had to license the PostScript interpreter from Adobe. However, most major printer manufacturers now have their own emulations. For instance, many of Hewlett Packard's inexpensive AIO printer/fax/scanner devices have PostScript emulation. You do need to make sure that the printer emulates at least Level 2 PostScript. Some Brother laser printers have BrScript 3 which is said to be a Level 3 emulation.

How do I setup the PostScript Printer?
If the printer is on the network, you need to find it's network address. Often, doing a test print from the printer will give you that information. If it's attached by an external HP JetDirect print server, pressing the test button on the print server will print the settings to the attached printer. If the network printer is already set up on the network, it will be using a custom port, and examining the printer settings in the Windows printer control panel will tell you what network address is being used.

You then need to put this IP address in the Settings/PostScript/Network Printer Address field. Put "9100" in the Network Printer Port field. These settings will now appear in the printer dialogs each time you want to print.

I have a PostScript Printer connected by the parallel port.
In that case, just tick the lpt1: box in the printer dialog when printing.

I have a PostScript Printer attached by a USB port.
Here are some instructions for using these with Synapse. The simpler method is to buy a USB HP JetDirect print server on eBay, but if you use these with a multifunction device, more likely you will lose the ability to scan/fax etc.

Advantages over LaTeX and PDF
Up to now, Synapse EMR has used MikTeX (LaTex) to generate PDFs for printing. But there was an occasional problem when Adobe Acrobat would print the wrong PDF - ie. not the one being viewed. Also, occasionally Synapse EMR would create some LaTeX which MikTeX flagged as an error. Nothing appeared to happen, but hidden behind Synapse EMR would be a DOS box with MikTeX asking for some input. However, 99% of the time LaTeX printing works and creates professional output, but will always be slower than direct PostScript printing because it has to generate PDFs first.

I don't have a PostScript Printer or I want print preview.
As mentioned above, you may have a PostScript printer if you have purchased Hewlett Packard laser printers. Also, refurbished PostScript printers can be purchased inexpensively from eBay. Make sure that they have network ports, or JetDirect print servers installed, if possible. You may leave questions on our board here about this.

Another alternative is to install a PostScript viewer, and print to a Windows printer from there. Hitherto we have suggested using the free RoPS viewer. However, this is only a Level 1 interpreter, and it seems unable to preview the new documents created by Synapse.

The choices are to install the RoPS 6.5 commercial level 2 PostScript viewer ( currently untested but has a 21 day evaluation ) which costs US$49, or to install GSView. The latter also requires that you install GhostScript. GSView has a nag screen to register which costs US$30. Installing GhostScript means that you can also use PDF Creator which allows you to create searchable PDFs.

How do I print?
In the new print dialogs there are two choices - "PSPreview" which invokes the installed PostScript viewer ( Settings/PostScript/PostScript Viewer ) on the output, and "PS" or "PS Print" which sends the output directly to the PostScript printer. If you don't have one setup, it will try and send it to the viewer instead.

Links:
Ghostscript
GSView

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Local backup of your database

Graham — Wed, 02 Aug 2006 21:05:00 GMT

We recently came across a neat and free backup scheduler that works for Firebird database tables.

FIBS allows you to schedule backups on the hour or minute, and also allows the backup to be compressed with gzip compression. FIBS uses gbak, the utility included with Firebird so that you know that your data is safe. Copying and compressing database files with non specific database utilities while the Firebird server is live is a definite no no as it can cause database corruption.

FIBS can also send backups to a ftp server, but since ftp is not secure, this would not be recommended. Reports of backup failures are optionally emailed to you.

Compression reduces the space of your data by 80% so makes it easier to take your data offsite. HIPAA regulations state that your data should be backed up and taken offsite daily.

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Database replication

Graham — Tue, 25 Jul 2006 18:43:00 GMT

One of the main concerns for ASP users has always been how they can access their data should there be a change of business circumstances. To ensure that our users are confident that they will always have access to their data in the event that some unforseen circumstances renders the internet unusable, we are making available an optional comprehensive replication service.

In order for this to happen, we will require one of our engineers to have full remote access to one of the client's PCs that has been setup for this purpose. Since this is intended to be used in an emergency, we consider that this PC need not be high end. A Pentium 4/AMD64 or higher, 256Mb ram, Windows XP Professional with 5Gb of free disk space would be suitable. Ideally this PC should be used solely for this purpose so that the database replication software continues to run without interruption without fear that the PC is shut down, or compromised by viruses/spyware. The client may also wish to have Raid 1 running ( disk mirroring ).

We will then setup replication software to ensure that replication occurs thru a highly encrypted tunnel to our servers. Replication cycles will depend on how often the client requires, and on which replication plan they purchase. Replication is an additional cost above plain hosting, and there will also be a charge for the initial setup.

During the replication process, all changed files only will be replicated back to the client's server. Binary differences in the database will also be replicated so that if the client has a 300Mb database, only the changes since the last replication will be transferred.

Please contact info@synapsedirect.com for more information.

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Reporting

Graham — Thu, 20 Jul 2006 12:35:00 GMT

Build 172, which requires server 0.0.52, marks the start of the implementation of custom reports. This build allows you to query patient, diagnosis, results, and medication tables in a single report. An example is given how to perform the following query

Find all females over the age of 50 with a ICD9 diagnosis of uncontrolled diabetes with an HbA1c greater than 7.5% with their last test being before 1st Jan 2006.

This query is generated using the QBE GUI editor. More complex enquiries are likely to be encoded for you to save you the time of creating them yourself. In the long term we hope to provide all the queries you need to satisfy P4P reporting requirements.

There is a caveat in that any complex queries will, when there are large numbers of records, tie up the database server so no other Synapse user can do anything until the query has been completed. This is a result of client database architecture. So, when you have large numbers of patients ( over a few thousand ) and results, it is best to leave performing such queries until the system is not being used by others.

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