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What Do I Do With My Paper Chart? — The Middle of the Road Makes the Most Sense

Written by  Seth Flam, DO, CEO, HealthFusion | Thursday, 02 February 2012 09:39
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Reprinted with permission from HealthFusion's blog HITFusions.

Many healthcare providers who are transitioning from paper charts to electronic health records need help understanding how to work with the paper charts they built over their many years in practice. There are three general approaches:

1. Scan all your paper charts and upload the scanned charts to the EHR. This approach is the most expensive approach. Typically, if a practice wants to take this approach, they outsource the scanning to a third party and have every piece of paper is scanned and uploaded into the EHR. The main advantage to this approach is that the paper chart becomes obsolete and can be stored offsite. The major disadvantage to this approach is the cost of scanning and uploading. Usually a practice will pay between $5,000 to $10,000 to the scanning company for the use and time it takes them to open each chart and high-speed scan every single SOAP note and test result.

Since the complete chart is available in digital format, the user never has to reference a paper chart, but the provider may have to wade through pages of scanned data to find the specific records that reflect the milestone events that best summarize the patient's medical history.

Rating: Effective – Very costly.

2. Scan nothing and carry the paper chart into the exam room. Physicians that promote this method still like the feel of the paper chart and generally have trouble making the commitment to an EHR in the early stages of adoption. The advantage of this method is that no scanning is required. The disadvantage is obvious; the EHR never tells the complete story regarding the patient history, especially with regard to certain milestone events that impacted the patient's health. The physician is committed to two systems all of the time for an indefinite period of time. The practice never gets the opportunity to save money by reducing chart pulls; the first visit is easier with this method — just pull the chart — but subsequent visits become more expensive with each additional chart pull.

Providers who desire mobile access to patient charts will likely find this approach unappealing as it requires always having a paper chart on hand to obtain a complete record for the patient. Instead, these providers will find the first or third approach more attractive, assuming they can access a web-based EHR systems, such as MediTouch EHR.

Rating: Least Effective – Least costly in the beginning, but expensive over time.

3. Scan only what you need. This approach is based on the premise that you don't need to scan every piece of paper in the chart; the assumption is that you don't need to see everything that happened in the past. With this method your staff scans "just enough," based on the provider's decision to competently care for the patient, and no more. Most practices find that scanning less than 10 percent of the paper chart gives them the data they need to provide the excellent care that their patients expect. The typical method requires some minor preparation the day before the patient is seen. The provider marks what records require scanning or the practice creates a "formula" for every chart. Formulas work in some cases, but provider input always helps to streamline the process.

There is clearly some work involved in preparing a patient file the day before a visit. However, scanning and sorting documents "in the cloud" with MediTouch EHR is simple because users can upload files in bulk (not one patient at a time), and then sort them into the appropriate chart once they are uploaded. Practice staff should populate the allergy and medication lists the day before to help the practice meet the meaningful use requirements for those list types (scanned images of those lists don't meet the CMS' meaningful use measures). The problem list, however, can be populated from the office visit SOAP note, so we do not recommend spending time on that one the day before. With MediTouch EHR, the  medication list can be imported from the Surescipts database, so manual entry is minimized. Even with the process automation built into MediTouch, offices should anticipate several minutes per patient, preparing the EHR for a visit — but only the first time a new patient is seen. This time investment reaps great rewards for the office because, when the patient returns for the next visit, there is no chart pull. In addition, all of the workflows related to adding lab results and incoming faxes to the chart are streamlined. The net result is that with regard to handling the chart, EHRs reduce work for the staff over time, but on the first visit an investment must be made.

Rating: Most Effective – Least costly over time.

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