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AS 2828.2:2019

[Current]

Health records, Part 2: Digitized health records

This Standard specifies the requirements for digitization (scanning) of paper health records. It provides technical specifications, data capture and implementation principles as well as quality control measures. In addition, it provides guidelines on best practice for safe storage, security, conformance and reproducibility of digitized health records.
Published: 24/07/2019
Pages: 30
Table of contents
Cited references
Content history
Table of contents
Header
About this publication
Preface
Introduction
1 Scope and General
1.1 Scope
1.2 Normative references
1.3 Terms and definitions
2 Digitization of health records
2.1 General
2.2 Processes for digitization of health records
2.3 Digitizing health record systems (DHRS)
2.4 Digitizing health record services
3 Processes for digitization of health records
3.1 Organization and management
3.1.1 General
3.1.2 Metadata and value domains
3.1.3 Planning for implementation
3.2 Clinical relevance
3.3 Design of paper health records, documents and forms
3.3.1 Application of barcodes and other OCR-readable identifiers
3.3.1.1 General
3.3.1.2 Use of barcodes and OCR
3.3.2 Barcodes specifying type of form or document
3.3.3 Labels identifying subject of care and episode of care
3.3.4 Use of intelligent character recognition (ICR), optical character recognition (OCR) and optical mark recognition (OMR)
3.4 Support for legal obligations
3.5 Quality processes
3.5.1 General
3.5.2 Quality control
3.5.2.1 Quality control requirements
3.5.2.2 Desirable characteristics of quality control processes
3.5.3 Quality assurance
3.5.4 Key performance indicators
3.6 Cybersecurity and access control
3.6.1 General
3.6.2 Unique access credentials
3.7 Retention and disposal
3.8 Maintenance and operation of a digitizing health record system
3.9 Planning for data capture
4 Digitizing health record system (DHRS)
4.1 Key Characteristics
4.2 Scanning and image capture
4.2.1 Scanning equipment
4.2.2 Calibration features
4.3 Image processing
4.3.1 Required image processing functions
4.3.2 Desirable image processing functions
4.4 Metadata
4.4.1 Role of metadata
4.4.2 DHRS metadata functionality
4.4.2.1 Required metadata functionality
4.4.2.2 Desirable metadata functionality
4.4.2.3 Episode-level metadata
4.4.3 Identification of digitized health records and documents
4.5 Digitized health record data capture and document management
4.6 Retrieval and viewing of digitized health records
4.7 Storage of digitized health records
4.7.1 General
4.7.2 Requirements for storage of digitized health records
4.7.3 Desirable measures for storage of digitized health records
4.8 Reproduction of digitized health records
4.8.1 Requirements for reproduction of digitized health records
4.8.2 Desirable features for reproduction of digitized health records
4.9 Control and logging of access
Bibliography
Cited references in this standard
[Current]
Information technology - Automatic identification and data capture techniques - Code 39 bar code symbology specification
[Current]
Information technology - Automatic identification and data capture techniques - Code 128 bar code symbology specification
[Current]
Information technology - ISO 7-bit coded character set for information interchange
[Current]
Health informatics - Audit trails for electronic health records
[Current]
Information and documentation — Metadata for managing records, Part 2: Conceptual and implementation issues
Content history
DR AS 2828.2:2018

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