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Migrating paper medical records to an EMR

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Paper Medical RecordThe volume of data that you shepherd into EHR-land depends mostly on the nature of your practice and your personality. Specialists who typically see a patient just once or twice don't have to worry about a wholesale migration of data. Their primary care colleagues, however, need to access test results and medication lists found in the paper charts of thousands of ongoing patients. How much they transfer to the EHR is a matter of preference.

Yet another fine article by Robert Lowes...

Switching from paper charts to electronic health records is like any conversion experience—it takes a little faith. However, patient data stored on a filing shelf doesn't miraculously move into a computer by itself. You've got to lend a hand. If you're going to install an EHR system, you have several conversion methods to choose from. All of them have been tested by other doctors who've gone down this road, so learn from their experience.

DictationImport transcribed dictation. When FP Peter Muir's six-doctor practice in Springfield, OH, installed an EHR system in 2003, they were looking at 20,000 active paper charts. Fortunately, the switchover was relatively painless because the doctors had been dictating their notes and saving the electronic transcription files.

First, Muir's group automatically created the shell of a digital record for each patient when it imported demographic information from its practice management software. "Then we brought in three years' worth of transcribed dictation and filed it in a 'documents' section of each record," says Muir. "The dictation contained much of the information we needed to move forward." His group is slowly phasing out paper charts, beginning with ones for inactive patients. Those records are being scanned and burned onto CDs apart from the EHR.

KeyboardKey in basic data. You can type the essential information found in a patient's paper chart—the problem list, the medication list, recent test results, the latest history and physical exam, etc.—into data fields of his individual electronic chart. Some doctors prefer to handle this clerical task themselves because they don't trust staffers to recreate the record accurately. If you do assign this job to a staffer, you're giving him or her a great EHR tutorial, says Rosemarie Nelson, a computer consultant in Syracuse, NY.

After you decide who's going to key in the data, you need to decide on when. One option—which could take several months—is converting all the charts before you begin using your EHR system. The other option is the gradual approach—entering data as charts are pulled for appointments. The same technique applies to scanning, which we'll discuss next.

Scan PaperScan as you go. Having the ability to scan paper into your EHR is imperative. Otherwise, you'll drown in the hard copy that pours into your office from healthcare's technological backwaters. Accordingly, you need to invest in a scanner or two as well as the necessary software, unless your EHR program already comes with a scanning module.

Since you have this scanning technology in hand, the argument goes, why not use it to copy a patient's paper chart into the EHR when you book him for his next appointment? That's the advice given to doctors by Sam Bhat, vice president of sales for EHR vendor eClinicalWorks. This approach guarantees, says Bhat, that you'll convert charts for only those patients whom you'll see in the future—an important consideration for specialists whose patients tend to be one-episode affairs.

Bhat also recommends scanning just the guts of the paper chart—the medication and problem lists, the most recent progress notes and lab results, etc. Solo FP William Soper in Kansas City went that route when he implemented his EHR system in 2000. "We scanned maybe six to 10 pages per chart," says Soper. "It took a file clerk about two minutes to do it."

Once a patient schedules an appointment, Soper adds, a staffer can scan the record either before or after the visit. In the latter scenario, the physician uses the patient chart during the visit and designates pages that he wants imported into the EHR.

Scan PaperScan it all at once. Scanning to the schedule, as the technique is called, has drawbacks. It may take up to a year before you cycle through your patient base and their paper charts. In the meantime, you're operating a dual record system—electronic and paper—that can frustrate your efforts to implement the EHR. And incremental scanning may overwhelm your staff, especially if you book a lot of patients for same-day or next-day appointments, giving you scant lead time to feed paper into a groaning machine.

"Naive practices assume that they can fit this into their work flow," says Rosemarie Nelson. "You may need to hire extra staff."

Bulk scanning before you go live with an EHR system avoids these problems. While you theoretically could assign this job to your staff—and who knows how many weekends it would take—it's best to rely on an outside firm with the kind of high-speed equipment, manpower, and expertise that can knock off your paper charts in a matter of days.

Scanning companies typically charge a basic rate of 5 to 15 cents per image, depending on volume. Prepping each piece of paper—removing staples, undoing dog-ears—can add a few pennies more, as can indexing images so they match up to individual electronic charts. The cost of scanning 2,000 charts averaging 30 pages apiece could easily top $5,000. Scanning just the essentials of each record trims the bill considerably.

Bulk scanning deprives you of paper charts for several days. To minimize the disruption to your practice, hold back the paper charts of patients who have appointments during Operation Scan and do those later. Or, schedule the work for a weekend (and expect to pay more per image) or when you're on vacation.

Not every practice can afford to bulk-scan, but for St. Louis internists Rick O'Neill and Vinay Kamat, this approach ultimately made them money. In 2005, the partners paid a local scanning company almost $10,000 to transform 4,000 charts into digital images as part of their EHR implementation. O'Neill and Kamat then rented out what used to be their file room to a company that performs echocardiograms and vascular studies on-site. "The revenue in the first year was more than four times the cost of the scanning," says O'Neill.

The two St. Louis doctors later shredded their old paper records since they had scanned them from front to back. However, if you partially scan your charts, type in core data, or import transcribed dictation, you should play it safe legally and hang onto your paper charts, says Lee Johnson, a healthcare attorney in Mt. Kisco, NY. Bulk scanning, therefore, eliminates the expense of off-site storage.

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Last Updated ( Sunday, 06 July 2008 20:11 )  

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