My practice is moving to an EMR, what do I do with all the patient records in our chart room?
You will need to choose between one (or a combination of several) of the following options:
1. Continue to store them in your existing on-site chart room
2. Scan them and attach them to the electronic patient record in the new EMR
3. Scan them and store the images in a repository that is separate from the EMR
4. Store them off-site at a business records storage facility
5. Store them off-site in self storage space
Why should I scan my old charts?
The main reason to scan your charts is to improve patient care and
reduce liability by making them easily accessible to your physicians and
staff.
If you don't scan your charts, you'll be forced to manage two systems -
one that is electronic and one that is paper based - a "hybrid" system.
Managing both systems can be frustrating, inefficient, and potentially
result in poor patient care. A hybrid system usually results in slower
adoption of the EMR and it's not uncommon to see physicians in an exam
room with a tablet PC and the paper chart.
When you receive release of information requests you can provide the
information faster, cheaper, and more securely than retrieving and
copying or scanning paper files and mailing or faxing them. You can also
turn the release of information request into a revenue generating
opportunity.
You'll have a large portion of your office space consumed by files and
all of the labor costs associated with managing those files. Wouldn't it
be better to convert that space into another exam room or use it for
some other revenue generating activity?
Off-site storage may appear to be inexpensive, but if you have to keep
your records for an extended period of time (pediatrics, women's health,
urology, etc.) storage charges can greatly exceed the cost of scanning
charts, especially if there is a high level of retrieval of charts from
off-site storage. Storing charts in a self-storage unit could be a
potential HIPAA violation. Self-storage units are often targeted by
thieves, putting patient information at risk.
Once my charts are scanned, do I need to keep the paper chart?
In most instances, you can destroy the paper as long as you have scanned
the entire chart. We advise that you consult a trained legal
professional to ensure compliance with all laws and regulations
pertaining to your specific practice.
Do I need to scan the entire chart?
Some practices choose to scan only certain sections, but you may be
forced to keep the paper if you don't scan the entire chart. You may be
faced with maintaining two separate systems, one paper based and one
electronic. How will you know what information is in which system? How
much will it cost to continue to staff the chart room with medical
records staff? If you eliminated the storage space, could you add
another provider(s) or diagnostic equipment and generate more revenue?
These are all questions to ask yourself when making this decision.
Another important thing to take into consideration is potential future
litigation. You could find yourself in a situation where you have
conflicting information in the paper chart that wasn't brought into the
electronic medical record that could be damaging in the event of a
malpractice or other suit. You need to make sure you keep information
for the required amount of time and if your records aren't integrated
you could potentially miss information that could affect patient care.
It is also not uncommon for us to find multiple charts for the same
patient when we do a conversion. Scanning all the charts is an
opportunity to clean up your existing patient information.
Do I need to scan all my existing charts?
Different practices have different needs. In many cases, we recommend
that only charts for patients that have visited in the last 12-18 months
be scanned. In some specialty practices like Pediatrics, charts may
need to be kept for up to 28 years. The cost of storage for that length
of time will exceed the cost of scanning the charts. Our consultative
process includes an assessment of which charts should be scanned and
which might be better serviced by a secure document storage company.
If you have older charts and the patient hasn't visited in a long time,
those charts may not be worth scanning. You'll want to make sure you
have a mechanism in place for destroying old charts once they meet their
retention requirements. Keeping the paper chart exposes you to
liability in the event of litigation if you have kept records that could
have been destroyed once they met their legally mandated retention
requirement. All records that you have, whether they are paper or
electronic, are discoverable in the event of a lawsuit. It can be
challenging to manage records retention if you have more than one
repository.
Why don't we just hire some temps to scan our charts?
Practices tend to look at three things when they make this decision. The
cost of a scanner, it's rated throughput, and the "low cost" of
temporary (or family member) labor. The labor costs of prepping the
charts (taking out paper clips, staples, etc.), indexing the charts, and
quality control are often not factored into cost estimates for in-house
scanning. These items combined typically cost 2-4 times as much as the
actual scanning.
Perhaps you already have a scanner or a digital copier that can scan. A
service bureau will use equipment that can capture 4 or 5 times as many
pages per minute as most copiers or office scanners, greatly reducing
the labor cost per image. If you use a digital copier, you will have
people "fighting" over the resource and the person doing the scanning
will be frequently interrupted, decreasing efficiency and increasing the
chance of mistakes.
Typically, the same person doing the scanning is also removing paper
clips, staples, etc. to get the charts ready for scanning and then
indexing the charts after they have been scanned. The net result is that
the scanner is often sitting idle and the actual throughput is about
20-30 percent of the scanner's rated speed. The project you thought
would take 4 or 5 months ends up taking two years!
Since the same person is often doing all the work, the chance for
mistakes increases exponentially. A service bureau has different
personnel working on each step of a tightly controlled and carefully
designed custom workflow process so that work is always being cross
checked. A quality service bureau will also have an independent quality
control step built into their workflow to ensure all pages were scanned
and legible.
A service bureau will have a team dedicated to your project allowing it to be completed in weeks, instead of months or years.
An experienced service bureau utilizes high end production scanners,
state of the art workflow management tools, and has developed processes
over the years that result in a highly efficient quality driven process.
While scanning seems relatively simple, there is a big learning curve
and it just doesn't make sense to try to re-invent the wheel.
We have had to re-scan entire chart rooms for practices that didn't have
a good quality control process. Patient information was indexed
incorrectly, inter-mixed in other patient charts, and illegible. We've
also had practices that did their own chart scanning tell us that their
project took months longer than anticipated and ended up costing 2 or 3
times as much as we quoted.
We utilize advanced technology that allows us to automatically separate
the charts using the same tab methodology you use in your paper charts
and we utilize existing patient demographic info to automate the
indexing process, provide more search information, and improve accuracy.
Charts scanned by an experienced service bureau will be easier to use,
accurate, and all images will be legible.
Temporary employees are often overlooked when it comes to confidentiality and HIPAA training.
What about patient confidentiality?
We ensure HIPAA compliance through a combination of personal
accountability and physical security. All employees must undergo
criminal and credit background checks prior to employment and execute
confidentiality agreements as a condition of employment. We provide
ongoing HIPAA training. We utilize an independent auditor that performs
an annual HIPAA compliance review. We execute Business Associate
agreements with all customers and carry a high amount of liability
insurance. Our scanning facilities are secure locations that are locked
24/7 and under 24/7 internal video surveillance. All employee work
activity is tracked to the file level for every project.
What if we need a chart while you're working on it?
We utilize a secure e-mail solution that allows us to e-mail a scanned
chart to you if you need it while we have it at our scanning center. We
can also provide encrypted FTP access and in some cases we can send it
directly to your EMR. We work with clients to schedule the project so
that only a small portion of your charts are in our facility at any one
time.
Do we have to scan them all at once?
Some practices prefer to spread out the scanning expense and we will
work with you if you need to spread your budget over a period of time.
Some practices send us their charts once a week after patients have
visited. Others send us charts for the patients they have scheduled for
the upcoming week so that they are available in the EMR when the patient
visits. Both of these options ensure that you're only scanning charts
for active patients. We've also had practices that send a pre-determined
number of boxes each week to spread out the investment.
When preparing for an EMR migration, many practices perform a pack and
purge each year. Instead of sending the oldest year of Medical Records
to an offsite storage facility the records are scanned and held in an
online archive until the go live date for the EMR implementation.
Can you scan into our EMR system?
We have performed dozens of conversions into a multitude of EMR systems.
To date, we haven't found any that we haven't been able to scan into
and we currently have templates built for most of the major EMR systems.
Do you offer other solutions for medical practices?
We are constantly looking for other ways to add value to our
relationship with the medical practices we serve. We have developed cost
saving solutions that automate revenue management, release of
information, and other time consuming manual processes. We provide
solutions that eliminate labor and manual data entry including
conversion of paper EOB forms into a Medicare compliant 835 EFT file. We
also provide an audit solution for comparing the maximum reimbursable
amount in your contracts against actual reimbursements.
Do you work directly with EMR providers?
A number of EMR providers recommend our services to their customers
because they know we do quality work and have the technical expertise to
format the scanned charts correctly to make them available in their
EMR. We actively partner with the EMR providers and understand how their
solutions work.
What else should I take into consideration?
Clients often wrestle with the issue of whether to scan the entire chart
or not. If you think you don't need to scan the entire chart, ask
yourself a few questions. Will the time spent weeding out pages end up
costing the same or more than simply scanning those pages? Am I putting
patient care at risk by not having all the pertinent information I need?
Am I exposing myself to liability by keeping records that could be
purged? What will my storage costs be? Can I put the space occupied with
charts to other use as an exam room or the home of a new piece of
diagnostic equipment that will generate revenue?
