Implementation of an EHR technology at a facility usually begins with deciding on what to do with the old paper records and how they should be transferred into the EHR system.
The processes of converting paper records into an electronic format vary from user to user, however, it is unanimously admitted to be a time consuming as well as costly exercise (especially the process of scanning each record). Depending on the size of the practice, the entire conversion can take several months.
There are three primary options available for feeding the old records into your new EHR system –
Option 1: Scan all the documents.
There are a several advantages of choosing this option –
(a) All your records are converted to an electronic format.
(b) Old paper records can either be destroyed (state laws governing the destruction of medical records differ from state to state) OR they can be securely stored at an offsite location.
However, there are some disadvantages as well –
(a) The scanned images are in a PDF format and cannot be easily searched for to locate specific information.
(b) Once the records are now in an electronic format, the scanned images still have to be sorted and saved in appropriate sections of the EHR system.
(c) The process is costly as compared to manually feeding the data into the system.
Option 2: Scan only the critical documents and keep the remaining information on paper records.
This option has all the advantages of option (a) but doesn’t completely eliminate the need for paper records and physicians still have to refer to the paper records for data that’s not available in electronic form.
Option 3: Manually feed in all/part of the data from paper records into the system.
This method is on average the most favorable since the data entered into the EHR system is easily navigable and can be quickly searched for key information.
While there may still be some scanning required for feeding in images and scans, a non-medical staff-member or a part-time data-entry specialist can be employed to feed the bulk of records into the EHR system since no specific medical knowledge is required for this task.
It’s an advantage if physicians enter the data themselves because they get to take a fresh look at patient history in the process; the data is bound to be more accurate too. There’s no doubt that this can take up a lot of time (and it’s not a revenue generating activity) – but if you can manage the task in small chunks over a period of time, it canturn out to be beneficial in the long run.
In conclusion, any option you choose will involve an investment of both time and money. But considering that you’ll need to repeatedly access and update hundreds of patient records every year, switching to electronic records will definitely boost the quality and productivity of your practice over the years to come.
Tags: ehr, EHR system, electronic health records, electronic medical records, emr, medical record scanning
3 Comments
ICMCC News Page » EHR Implementation: Managing those old paper records - Oct 7, 2009
[...] Article EMR Blog, 7 October 2009 SHARETHIS.addEntry({ title: "EHR Implementation: Managing those old paper records", url: "http://articles.icmcc.org/2009/10/07/ehr-implementation-managing-those-old-paper-records/" }); [...]
Mike Hawkins - Oct 8, 2009
Great article. We have found that even though the upfront costs are high, the elimination of paper-handling costs ( chart pulls and refiles, searching for lost charts, faxing, copying, retrieving from storage) for the practice will pay for the scanning over time. Our services have automated methods for separating sections of the chart as separate PDFs and associating with patient in EHR system. Additionally, we can leverage the ability to bulk import documents into an EHR system as opposed to the slow process of scanning into the system with a temp or admin staff.
Deborah Leyva - Oct 8, 2009
Migration from paper to electronic records is a daunting task, even for the sole practitioner. Although scanning paper records, as mentioned above, is one way to convert/migrate to a paper-less environment, the ability to meet meaningful use standards for reporting may not be met entirely by the scanned documents as the data they contain are not discrete elements that can be searched and reported.
That said, a migration over time, with selected patient priorities, may provide a more practical and cost effective approach. What do I mean? Well, selecting patients with critical conditions as “first movers” may provide improved care and clinical analysis of diagnostic information, while others can be implemented over a longer period of time, or as needs change. Depending on the criteria established for meaningful use incentives, specific patient information, in addition to the scanned documents, can be manually captured, or input, over a specific time period (e.g. historically and future use). In this manner, the scanned document is available and the data is converted into a format that can be reported as necessary.
The importance of having data in discrete elements within an EHR system is important for the required reporting to meet criteria for “Meaningful Use.” Examples of the types of analysis and reporting for clinics and providers (e.g. not hospitals/facilities) include things like:
- % diabetics with A1c under control
- % hypertensive patients with BP under control
- % of patients with LDL under control
- % of smokers offered smoking cessation counseling
- % of patients with recorded BMI
- % eligible surgical patients who received VTE prophylaxis
- % of orders entered directly by physicians through CPOE
These measures are part of the Meaningful Use Matrix, which established the criteria by which providers will be paid their incentives, and this type of data would be difficult to capture within scanned documents, unless the scanned document can be converted to (or “broken into”) discrete data.