Converting paper charts to electronic medical records tips

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert all of the paper records into electronic ones.

Since we started our EMR implementation with just new patients, we initially were entering brand-new data on those patients and there wasn’t anything to convert. But as we started adding established patients – those patients that had an existing paper chart – we had to deal with two issues: how much of the paper chart do we convert to a digital format and how do we make the majority of the existing clinical history available to the physician? Before I tell you what we did, let’s discuss some options for dealing with conversion of paper records to electronic records.

  1. All patient charts are scanned into the electronic medical records (EMR) system. If your practice is running out of physical office space, as we were, this is an attractive option. Unfortunately, it is easy to underestimate the cost in terms of man-hours. Note also that while the actual scanning of medical records can be performed by an unskilled temporary worker, a more highly-skilled employee is needed to actually file each of the scanned records into the file of the appropriate patient
  2. Partial scanning of patient charts into the EMR system. Employees will pull all the charts that are due for the coming week or the next workday. Then they will scan only the clinical information that is pertinent to their upcoming appointment. The physicians will need to decide what they consider pertinent: last three visits, the first comprehensive exam, a problem list, past medical histories, medication list, latest lab results, etc. Then when the doctor sees that patient in the EMR system, he or she can view all of the relevant scanned paper records right then and there. This is what we had been doing until recently.
  3. Scan every patient’s summary page into the EMR system. This is most useful if your practice has a lot of patients who are worked into your schedule or if you receive a lot of calls regarding patient questions or pharmacy refills. In this way, more patients start to have an electronic track record established sooner. Additional information can then be entered as they are seen in the office.
  4. Hiring an outside firm to scan all your charts into the EMR system. Yes, there are companies that will come on-site and scan and organize all of your paper records. But although they will usually have a lot of experience doing this, there might still be much work on your part or your staff’s to ensure that the records are being filed appropriately. If your practice has decided that scanning all of the records is a must, this option may be the most cost-effective in the long run. Nevertheless, it will still probably cost you a pretty penny up front.
  5. Don’t scan any old information into the EMR system. Start seeing all patients in the EMR system going forward and have the paper record pulled and available to the physicians for as many visits as they are comfortable with. New patients will need all of their information typed into the EMR system and established patients will need only their current visit entered (apart from their basic problem list, demographics, and medications for example). At some point, the doctors will no longer need to consult the paper chart and the umbilical cord can be cut. There may be exceptions to the no-scanning rule, such as important documents, labs, or imaging, and that’s okay. The goal is to minimize the amount of work spent on scanning information that is unlikely to be seen anyway.

OK, so going back to what we were doing: we were having the charts pulled beforehand, basic information scanned, last three visits scanned, last comprehensive exam, last couple of specialty exams (in our case, visual field tests and optic nerve imaging tests) as well as some other paperwork, and the chart was available to the doctor to view when the patient was seen.

When our CIO, Warren Brown, asked us whether or not we were looking at all of that scanned paperwork, our reply was, “No, because we can see it there in the paper chart.” As soon as we answered his question, we realized what a waste of time we were creating having our staff scan and file so much information that we were not even viewing in the EMR system. And although one could argue that this was not really wasted effort, we were creating a backlog of scanning and filing of more important, current information that we really needed to have scanned into the EMR system.

Now every practice is different, and what information needs to be converted into EMR may vary depending on your specialty. But hopefully this will get you thinking ahead of time so you can develop a proper plan to convert your paper records into digital ones in the most efficient and cost-effective manner possible.

Peter J Polack is an ophthalmologist who blogs on medical practice management and electronic medical records implementation on Medical Practice Trends.

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  • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

    This is a tough question and we have no great answers in our practice. When we converted four years ago, the doctors reviewed the paper charts and checked off what they want scanned. We left the existing paper chart in the office for review. When a patient left the office practice the chart was sent to a storage facility that recorded the chart and kept it for seven years until it was destroyed. We paid an annual fee for storage and destroying it. The fee was quite high. The retrieval cost if we needed the chart was quite high. The cost and time needed to scan material into the electronic record is very labor intensive. The key is labeling in what section of the EHR chart each document goes and labeling it so you recognize it and can retrieve it. At this point we are undecided if when a patient expires or leaves the practice we should just scan the chart onto a disc or flash drive cover to cover rather than send it to the storage facility for the seven years required by law? A part time high school or college student can do the scanning? The upside of all this is we no longer pull a paper chart to see a patient. It is all on the EHR. This saves a fair amount of time and work for the office staff. I think years ago the MGMA calculated to cost of pulling a paper chart and returning to the rack as $11.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    The high school student option is probably the cheapest. Get a cheap computer with a huge hard drive and have the student create a folder structure with sub-folders for each patient and scan everything in. Make one backup and ship it somewhere off site. It’s like having your own archive. If you ever need a chart, you can pull it down to disc or USB, free of charge.

  • stargirl65

    We picked a date after which everything was scanned. No information was scanned before that date unless the doctor specifically requested it. There were a few exceptions requested by the doctors. Minors charts (those under age 18) were generally scanned completely since they have to be kept so long. Charts that were so small that it made sense to simply scan the entire chart (the patient had been in only once or twice before we went electronic). Immunization records were scanned. Power of attorney paperwork and similar papers were scanned. HIPAA paperwork etc was scanned. The rest of the paperwork was simply stored and after 7 years the information is slowly being destroyed. We have only 2 more years until all paper charts can theoretically be destroyed. We do not scan in everything for new patients that transfer in with large charts. The doctor scans the records and copies in anything they feel is relevant from the old practice. The rest is returned to the patient for them to keep as they please.

  • http://www.innovativepdf.com ted rudolph

    Nice article. My question about hiring high school students is how do you do that and not violate HIPPA laws when it comes to patients privacy? Either scan it in-house, or hire a company to do it for you.

  • http://www.consentcare.net Martin Young

    Good post.

    I converted, (or rather my staff did!) all my patient folders to pdf a few months ago, using a good quick multipage scanner that does front and back pages together and automatically eliminates the blank pages. 8000 files takes up less than 2Gig of data, I can keep all my patients’ folders on my iPhone if I really wanted to – neatly secured of course.

    The most time consuming issue was taking out all paper clips and sorting the pages into order before scanning.

    I don’t use a formal EMR yet, but can do as much as I need to digitally using the pdf format, tablet PC, graphics tablet etc. It’s in effect my own free EMR record keeping system.

    It works for me.

  • http://drpullen.com Ed Pullen

    Best option is to decide well in advance, at least 6 months, ideally a year, what EMR you are going to use. Then have your transcriptionist add a header to each note that your EMR can use to electronically flow all your chart notes into the correct patient charts as progress notes once you get the EMR. We did this with the old Logician, now Centricity by GE EMR 13 years ago. It’s really simple, inexpensive, and worked great.

    Then we simply manually got childhood immunizations, now wouldn’t need this with the state data base and a tool to extract that as granular data too.

    I think of the ideas above the pull the chart each visit until the doctor says they don’t need it, then store or scan it is best. Scan needed documents.

    Still better to plan ahead and automate the progress note transfer.

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