Added under EMR Tips by Andres Paglayan in June 20, 2010
This is a description of a proven method to migrate paper charts to your new EMR-Bear. It might as well be a useful reference for any other EMR migration.
Many implementations are known for having a huge impact on productivity. This is mostly true due to the lack of organization. Some other times the problems are due to over-thinking, over-meeting, and resource over-spending to discuss and engineer a process that is rather simple and straight forward.
Pre-requisites, Processes and Storage will be discussed and guidelines provided to help you implement you own policy and methodology in an effective way and short time.
The pre-requisites for starting the paper migration to EMR are the following.
Scanner
Have a good quality scanner that supports document feeding, automatic conversion to PDF (Adobe Acrobat’s portable document format), and double side scanning. Most clinics and office settings will find that they already have such scanner embedded in the photocopier they are leasing. If no scanner is available or if you choose to have an extra one, which is not a bad idea, then the Fujitsu snap-scan series are an excellent and affordable choice.
Scanner methodology
Decide whether your will partition the chart in sections or if you’ll input the scanned charts as a single entity.
If you don’t paper have charts partitioned by tabs or sections, rest assured that this it is not the time to re-visit your paper charting policy, just have them scanned in a single PDF file.
If you already have the paper chart separated by tabs, use the same section separation for scanning the charts. If a chart has content in three sections you will end up with three PDFs, one for each section.
Thin charts, composed by less than twenty or thirty pages can be condensed in a single section and scanned as a single chart.
Some clients have really big charts, the best approach is divide them in chunks and give each section a sequence number.
Have the target Sections already defined in your EMR-Bear.
The naming of the sections depend on the internal policies you implement. In this case, flexibility can play against effectiveness. We recommend that you pick one of two approaches.
1./ Attach all scanned charts to a single section, (this can be named collaterals, imported chart, paper records). Specially convenient if your paper charts are not divided into tabs or if you don’t have charts to import.
2./ Attach each section of the scanned chart to the matching section in you EMR-Bear chart. Specially convenient if your charts are already divided by tabs and you decided scanning each chart in multiple files.
File naming convention.
An important issue many times forgotten is to be consistent in the way files are named. My personal taste is: Do not use spaces, but _ (underscores) instead; do not use capital letters, write all in lowercase; use very descriptive names; always use the last name first and include the DOB; use as much as meaningful data as possible
Some examples can be:
doe_john_1964_04_23_full_chart.pdf (John Doe, DOB of April 23 1964, the whole chart)
doe_jane_1964_03_25_correspondence.pdf
doe_jane_1964_03_25_labs.pdf
doe_jane_1964_03_25_clinical_info.pdf
o_anna_1963_06_15_full_chart_01.pdf
o_anna_1963_06_15_full_chart_02.pdf
Having a name convention like this could save many headaches in the future.
The no-Scanning Method.
An almost valid option for some practices where the scanning task might seem daunting is just not to scan the old paper chart. In this scenario if you run the math on the resources used for fetching and re-placing the chart and maintaining a dedicated in-office storage location you might change your idea pretty fast.
Scanning Method.
The best way to convert the paper charts into paper is to scan them as you see the clients, as soon a the scanning load starts to decrease due to repeating clients, jump ahead by scanning the charts of clients with the next future appointment and un-scanned chart.
When you see a client for the first time on EMR-Bear, get the paper chart as usual and go to the encounter with the paper chart as a reference. After documenting the encounter, give the paper chart to person responsible for scanning (more on this later), this should be last time you see the paper chart. The next time you see the client, the paper chart will be attached to the EMR-Bear client’s electronic file.
The scanning load is usually higher at the beginning due to two factors. The person scanning is not yet used to the task and the paper chart load to scan is higher at the beginning.
There are two more issues that derive from the scanning procedure. Who’s in charge of scanning and where do the paper charts go, being the first one the most delicate one.
The person responsible for scanning needs to be comfortable with the use of a computer and be better at it than the average user. There are variables that affect this decision that we cannot cover in this article. Post a comment with a punctual and specific question if you want some insight in your specific project.
In solo-offices with no extra personal the options are simple, It’s either the practitioner her/himself doing the scans, the multi-tasking receptionist if there’s one, or if none of those options are viable, then consider hiring a temp. Scanning charts can be a great summer job for a student or a young relative.
In practices with multiple human resources it is known both, that there are a lot of people with idling time that could take on the task or part of it, and that people with idling time will hardly recognize such. For big practices that can take the toll in hiring a temp, we recommend that they do so skeeping all the HR dances.
Paper Storage
Scanning and storing the paper chart go hand in hand.
The law on storage differs from State to State, some will allow destroying the original once a scanned copy is in file, other’s will ask you to keep the originals. Obviously we cannot advise in this mater, and you should consult with a Lawyer what is best for you. Said so, there seem not to be a law against keeping the paper charts as long as they are safe.
First get sturdy filing boxes, the cheap ones will fall apart with time (and humidity).
For the storage, forget about sorting by alpha or by chart id, or any other method, they are all unpractical. EMR-Bear provides a field in the client’s e-chart to identify where the paper chart is located and will tell visually if a client has an scanned chart or not.
Depending on your storage methodology, either self storing or third party document storage service, you’ll have to set your own storing convention or abide by that of the document storing company.
In a nutshell, when you store stuff, you label the box and you create a record saying what’s in each box. In the case of EMR-Bear, you edit the client, and insert in the client’s e-file the box name where the paper record is located at.
Examples of naming conventions for the filing boxes. If you have your own shelf rack, name the rack units, the shelves and the boxes and use that order to locate a box. A record placed on the first box of the second shelf at the third rack can be named as R3-S2-B1 (Rack three, Shelf two, Box one). This convention is a little more verbose and tedious to data-entry than 3-2-1 but less prone to errors. You decide.
Locating a paper chart will be as easy as getting the client file and looking at the chart location to retrieve the box where the paper chart resides in.
If you are using a third party storage company, they will provide you with pre-printed labels for the boxes and you just use the same label as that of the box you are putting the record in.
Summarizing, what it can take months of meetings, sub-committees, consulting-fees and resource wasting can be reduced down to only five simple points. Have a good scanner. Decide if you’ll go with single scan, multiple section scan, or a mix of both or none. Know who is in charge of scanning. Resolve the file naming convention. And decide on paper storage policy. By all means, avoid setting up a meeting to resolve any of those questions.
This post is open to discussion. Feel free to comment with a punctual and specific question if you would like to receive or share insight about your specific project.
Thank you for reading and happy migration!
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