EMR and A Simple File Format

In our clinic we’d been scanning all of our various documents in as PDF files for the past 4 years. We just recently came across a better scanning application that would do a better job scanning documents into our EMR. It was a change we just had to make, because the new scanning program saved us a bunch of time in the scanning process, but….

Yes, there always has to be a “but” in there.

Turns out this new scanning application scans documents in the .tiff format. This is still a really nice format since it can handle multiple pages in one file and is still quite small. Not a problem right? Windows comes with some really simple, but workable programs for viewing image files. However, for some reason our installs didn’t recognize the .tiff (yes it’s 2 “f”s for some reason) file extension. For a tech person, creating this file association is a real no brainer. The problem is that we have over 100 computers in our health and counseling centers. That’s a lot of computers to have to go around and create the file type association.

The point of this story isn’t the specific problem. Instead, it illustrates one of the major challenges of an EMR (and really the technology to use an EMR) even AFTER you’ve implemented one. Little changes like the type of file type used when scanning can cause untold frustration in a clinic. When dealing with technology, it’s the details that really matter. Make sure you’re working with IT people who understand and plan for those details. Otherwise, prepare to want to throw your computer through the window. Trust me. It will happen.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • My gut tells me that saving documents as pdf still allows the system to search (and index) the text. Saving as tiff makes the document an image, meaning that it loses all integration possibilities. The loss of that functionality would seem to negate any other advantages to using the new scanning software.
    Does anyone with more experience in file formats have input on the topic?

  • Actually, you can create text searchable tiff images which work very similar to the PDF files.

    However, the file format for the scanning isn’t really the point. The point is that a small change of the file format used for scanning can cause a lot of heartache to a doctor who just wants to view the document.

  • Most people with any IT background would consider changing the file type much more than a little change that would need to be investigated and tested prior to making such a change.

  • I’m not sure I’d say changing the file type is a huge change. Certainly is something worthy of note and needing to be tested and planned for.

    The problem is that many doctors offices don’t have the IT support in house and so they might have to wait for a response. Plus, what can seem like a little change to a doctor and not worth IT support can have a big impact on the workflow if not planned for correctly.

  • When a practice has a large number of systems in multiple locations, a good IT organization (internal or external) should create an infrastructure which allows for remote updates (i.e. so you don’t have to visit each and every computer in person). It takes a certain amount of forethought, and doctors have to rely on people who may or may not have the experience which leads to such foresight.

    Enjoy reading your blog (as investors, we’re very interested in the EHR/EMR space).

  • Mike,
    Highlight and underscore the “good” and “should” in “a good IT organization (internal or external) should create an infrastructure which allows for remote updates”

    Now you understand why these little changes can be such a problem for many.

    Glad to have an investor reading my blog. I’ll remember this if I decide to go the entrepreneur route.

  • In the specific case you cite above, could you insert a “convert TIFF to PDF” step in the workflow (ideally, automatic) to preserve the downstream flow?

  • Certainly that step could be added, but it was easier to just change the file type association for the .tiff files to use a certain program. In fact, I scripted it and pushed it out using active directory, but most doctors offices won’t have that option or don’t have enough computers to need to do that.

    For OCR, we could just click the OCR button still in the tif format, but it’s not worth the extra time and space required to OCR the documents that are being scanned.

  • Since you have already made the change this might be after the fact. Fujitsu ScanSnap does double sided single pass to .pdf. If you ever change again or for those considering a scanner they are good for time efficiency.

  • Anthony,
    I’ve actually heard good things about the Fujitsu ScanSnap. In this case, the change was to be able to scan directly into the EMR. Doing so cuts down on errors, simplifies the steps, etc. So, changing scanners wouldn’t really resolve the file type issue. Of course our EMR could have solved this issue.

    On that note, we love the Fujitsu scanners that we have: https://www.healthcareittoday.com/2009/03/02/best-scanners-for-high-volume-scanning-in-a-doctors-office/ They are complete work horses and have done great going on 4+ years.

  • Just keep in mind that: if your document is textual, the information should be stored as text — ie, cut-n-pasteable. For archiving purposed, there are basically three text formats you can use: plain-text (web-readable basic 7-bit ASCII with no bolding or other formatting frills), HTML (web-readable with formatting), and non-image PDF (web-readable, formatted in the original document style, and with pictures). These three formats are also quite compact compared to TIFF and other imaging formats.

    MS Word, Excel, Powerpoint are proprietary formats, probably none of which will open on your computer twenty years from now. And that’s not mentioning those (20 percent?) of us who choose not to by the packages required to read these formats.

  • David,
    The problem with scanning is that really need the image so you know what the documents looks like including things like a signature. In fact, if it’s just text we’ll almost never scan it. We’ll have captured it in the EMR itself. We’ve actually started capturing a patient’s digital signature as well using those signature pads you might find at Walmart.

    You can still open MS Word, Excel and Powerpoint. Just download the free openoffice.org 😉

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