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EMRs and the Paperless Medical Office

Posted on October 31, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

From the American Medical Association comes a recent story on EMRs and the paperless medical office. I think it touches quite effectively on the issue facing medical offices today – transitioning new patients to the new EMR has proved a lot easier than turning older paper records electronic. In one of my earlier posts, I’d written about this topic. This article provides some clever strategies in identifying which paper records to convert earlier than others.

Among the points discussed:
EMR use does not equal paperless: And yet, these two ideas somehow seem conflated in people’s minds. A doctor I spoke to recently said he had assumed that the EMR vendor would convert older paper records to electronic as part of the EMR purchase package. Well, the vendor might – for a fee. Electronic conversion ranges from simple paper scans to character/word recognition. For truly rich use of your data, say for report generation purposes, you’ll want something that populates a database. In fact, “data transfer probably is going to be a significant line item in the EMR budget.”

Not all data is equal: Having an EMR doesn’t mean that every little scrap of paper from the patient’s records needs to go into it. Doctors can make the call on the kind of data that they find most useful. It would however need some amount of planning and insight, not to mention time, to make this happen. What’s important depends on specialty as well.

Not all patients are equal: If a small proportion of patients you see tend to be the ones that come for repeat consults, it might make more sense to get the entirety of their paper records into the EMR.

Don’t make a beeline for the shredder immediately: Really, this should be self-intuitive. Unless you’re sure that every important piece of information you need has been transferred to the EMR, and the EMR data matches what’s on paper, don’t shred the patient’s records.

The only real quibble I have with the article was where it mentions that one company found that “having the doctors enter the data ensured the integrity of the information and helped them learn the new system.” Seriously? Have your $200+ per hour physician enter older records into an EMR, when you can get a temp or third-party vendor to do it for a fraction of the cost?

The statistics at the end of the article are quite interesting. The first statistic is especially encouraging.

A survey of 200 health IT professionals found that hospitals are taking varied approaches to digitizing their records. (Respondents could give more than one answer.)
49% have scanned what they need and stayed within their budget.
23% are within budget but still have a backlog of records to scan.
54% are scanning records onsite.
29% are using a centralized scanning location.
72% are relying on full-time employees to scan.
9% are using third parties.
6% are using part-time staff.
44% are not explicitly measuring the effectiveness or productivity of their scanning process.
58% plan to shred paper records once scanning is complete.
38% plan to store paper files in onsite records rooms or offsite storage facilities.

Source: Survey by information management company Iron Mountain, July

Hospitals Slow To Convert Paper Records, And May Not Know How To Manage Them

Posted on July 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Anyone who’s been around the HIT block a few times knows that the conversion from paper to digital records is going to be much uglier than the public thinks.  This new study from vendor Iron Mountain, however, offers some details that surprised even a cynic like myself.

The study, which surveyed 200 health information pros, asked them how they were doing with scanning paper medical records and how they expected to use the paper archives in the future.

One of the most interesting findings from the study, in my  view at least, is that while 70 percent of hospitals are claiming Meaningful Use Stage One rewards, 78 percent expect to use paper records for as many as five years more.

The study also found that hospitals planned to spend as much as $100 million just on the scanning process, a number which rocked me a bit even given the size of the  problem.  Iron Mountain researchers concluded that the costs are running high, in part, because institutions are using many different approaches to digitizing medical information.

Other data points from the study:

* About half of hospitals said they’d scanned what they needed to scan and were within budget

* Twenty-three percent of hospitals  said they were within budget for scanning, but had a backlog of records left to scan

* Once they scan their paper records, 58 percent of hospitals plan to shred  them, while 38 percent will store legacy records in an onsite room or offsite facility.

* Fourty-four percent of hospitals “are not explicitly measuring the effectiveness or productivity of their scanning process,” researchers concluded.

Though it’s interesting on its face, the study summary raises lots of questions.

For one thing, what metrics are 56 percent of hospitals are using to measure scanning effectiveness? Are we talking about accuracy of OCR performance, employee time invested, speed of scans, ease of retrieving stored data, or other measures?

How are hospitals with active EHRs keeping track of which documents have been scanned, which haven’t, which have been pulled and are in queue to be scanned and which have been reviewed for quality?

How will the 38 percent of hospitals planning to store paper records going to manage those paper records? Will staff have the ability to access paper records in a timely way if they need them?

I have no doubt that decent IT solutions exist to handle these issues. In fact, given that the banking business still exists, we know that one can move an industry from paper to digital records without a complete collapse. But as both an analyst and a patient, I wish I felt more confident that this particular transition is going smoothly.