Archiving Electronic Health Records – From Paper to PDF/A

Office files and all other electronic documents that the hospital, care facility or medical practice create themselves or receive via e-mail can be converted easily and securely into PDF/A using a PDF printer. In doing so, fonts are embedded or, optionally, only those characters that are actually used. As a result, the files fulfill the ISO specifications for long-term archiving to PDF/A.

According to an estimation from the “Gesellschaft für Medizinische Informatik Biometrie und Epidemiologie (GMDS)” (English: The German Society for Medical Informatics, Biometry, and Epidemiology) five million documents are generated annually in the German public health sector. More and more of these documents are scanned and entered electronically or are created directly on the PC so that they are only available in digital format. Without doubt, more and more hospitals, medical practices and care facilities switching over to a system of holding patient records in electronic form. The advantages of EPR include direct access to all of the information and a system of archiving that saves space. Sometimes documents must be preserved for 30 years or longer. PDF/A provides users with an ISO-standardized format for the long-term archiving of documents and images that guarantees their readability for decades. In addition, when compared to TIFF or JPEG, the appeal of PDF/A lies in its full-text capability, its support of metadata and the small file sizes – this applies in particular for scanned documents.

PDF/A for electronic patient records

Clinics and other health organizations must work as efficiently as possible in order to increase the so-called “health value”, in other words, the relationship between service/quality and costs. And, in the health sector, one cannot in any way afford to dispense with quality for the benefit of cost efficiency because this ultimately involves humans and not products. A workaround for this is provided by IT-supported processes, especially electronic patient records (EPR). This enables all of those involved in the process to be able to centrally access all of the documents. And this is not a small number of documents: According to an estimation from the Gesellschaft für Medizinische Informatik Biometrie und Epidemiologie (GMDS) (English: The German Society for Medical Informatics, Biometry, and Epidemiology) five million documents are generated annually in the German public health sector. More and more of these documents are scanned and entered electronically or are created directly on the PC so that they are only available in digital format. More and more hospitals, medical practices and care facilities are switching over to a system of holding patient records in electronic form. The advantages of EPR include direct access to all of the information and a system of archiving that saves space. Sometimes documents must be preserved for 30 years or longer. A format for this has been available for some time and this format was specially designed for the long-term archiving of documents and images: PDF/A. In addition, when compared to TIFF or JPEG, the appeal of PDF/A lies in its full-text capability, its support of metadata and the small file sizes – this applies in particular for scanned documents.

PDF/A – Readability of patient records for a very long term

PDF/A is the ISO standard 19005 for the long-term archiving in the PDF format. It represents a localized variant of PDF. This and other regulations guarantee the long-term readability of the documents – and this is irrespective of the software and operating system that were used to create the documents. In the public health sector, PDF/A is very well suited to the long-term archiving of patient records.

Heterogeneous document classes are a particular feature of patient records. They incorporate the usual Office documents in black and white as well as X-ray images, colour forms, unstructured hand-written documents or findings and EKGs. For this, tools must be available that enable these different documents to be digitalized, compressed, stored in PDF/A and quickly relocated as required. For the latter, above all, the option to perform a full-text search is essential.

PDF/A tools provide simple implementation

Analogue documents (in other words, documents in paper form) must first be scanned. Simple tools then simply embed the scanned files into a framework that is compatible with PDF/A. In addition, advanced solutions are available that convert all of the usual scan formats (such as TIFF, JPEG, PDF and others) into files that conform to PDF/A. You can also use special compression methods for this (such as the layer technique) that lead to minimal file sizes. The otherwise extremely comprehensive data volumes of digitalized X-ray images or colour documents are therefore reduced to a maintainable quantity. Colours are maintained and ensure that the reproduction is true to the original and that it can be easily read in relation to the readability that readers are used to from paper documents. In addition, the full-text (OCR) of the created documents can be searched and can also be provided with a digital signature.

PDF printers are often used for documents that were already created digitally. This concerns print drivers that are activated from the application via an interface. The conversion can occur based on the client or based on the server. For example, Office files and all other electronic documents that the hospital, care facility or medical practice create themselves or receive via e-mail can be converted easily and securely into PDF/A using a PDF printer. In doing so, fonts are embedded or, optionally, only those characters that are actually used. As a result, the files fulfill the ISO specifications for long-term archiving to PDF/A.

So-called PDF/A validators exist in order to ensure that the patient records that were converted into PDF/A also fulfill all of the ISO requirements before the final storage in the archive. As a result, users benefit from the security that, for example, even documents that are sent from third-parties are correctly archived.

About Thomas Zellmann

Thomas Zellmann ist seit über 30 Jahren in der EDV tätig und hat daher umfangreiche Erfahrungen mit klassischen und modernen IT-Lösungen. Er hat seine Tätigkeit für LuraTech in 2001 begonnen. Vor der LuraTech war er u.a. für die Softmatic AG, die Software AG und Nixdorf tätig. Thomas Zellmann betreut den Schwerpunkt Banken und Versicherungen sowie Archive und Bibliotheken und ist Gesellschafter der LuraTech.
Als Geschäftsführer der PDF Association ist er für die Koordinierung und Durchführung der meisten Aktivitäten der PDF Association zuständig.
Sie erreichen Thomas Zellmann unter  thomas.zellmann@pdfa.org

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