Records Management Blog | Practical Records Management

What to do With Paper Patient Charts When Transitioning to Electronic Medical Records

Posted by Matthew Petito on Mon, Apr 18, 2016 @ 02:40 PM

As Doctors across the country transition to Electronic Medical Record Systems, they’re confronted with a major decision, what do I do with my paper charts? Practices and Doctors have a few options to choose from:

  1. Continue to use the paper chart for all patient visits.

Yes, Practices have the option to not implement an Electronic Medical Record System and continue to use paper charts like they always have. Financially is it the best option? It depends on how much of a penalty the practice will have to pay. Will operations and efficiency change? Maybe, they will probably remain the same but eventually start to decline.

With the volume of patients increasing, and patients wanting instant access to their records and answers to medical questions, patient satisfaction may begin to slip and small problems of the past may become large problems in the future.

  1. Use both, the EMR for day forward patient visits and use the paper chart when reference to historical information before the EMR was implemented.

Most practices start the EMR transition with this option first, and it is a good way to ease into having electronic records. All important information is imported into the EMR (vaccines, allergies, some medical history, etc.) and the EMR is used on a day forward basis. If there is a specific piece of information that is not in the EMR during an office visit, the practice can locate the paper chart and reference that piece of information.

The practice will be electronic going forward, but they still will have the same issues with maintaining a paper medical record archive that they had previously. Time spent searching for charts, searching for misfiled charts, needing space to store and maintain a paper archive (paper charts need to be kept until the patient’s retention period is up, regardless of what information is on paper and what is in the EMR), and not finding charts.

This option is a good starting point, but with time, the practice should consider taking the active paper patient charts, scanning them, and uploading them into the EMR.

  1. Scan active patient charts and reference historical information as electronic images in the EMR. Store inactive patient charts and have the ability to scan these charts ‘on demand’ if/when a chart is needed.

This is the most cost effective approach to transition to an EMR, convert the paper medical records that are actively being used by the practice, while retaining the inactive paper charts physically. The inactive charts can be stored at the practice or at a record storage facility with the ability to pull, scan, and electronically send a requested chart on demand.

All active paper patient information is scanned and the images can be referenced either in the EMR, stored on the practices internal network, or a document management system outside of the EMR. The three options for viewing the electronic images can be chosen by practice, and all three are great ways to host, search, and retrieve scanned patient information.

For the inactive patient charts, (each practice has its own definition of active and inactive), it may not be finically possible to scan all their information. But, the records can be stored at a secure, offsite storage facility, and have a patient manifest created (Ex. Box 1 contains these 25 patients). A patient’s chart can be requested by the practice and scanned ‘on demand’ and the scanned patient chart can be delivered to the practice within a few hours or less.

This is the most cost effective option, to have active patient charts instantly accessible either in the EMR or an internal network and have inactive charts securely stored physically but can be electronically delivered when requested.

  1. Scan all charts into the EMR.

No office is 100% paperless, but this is as close as they can get. All patient charts are scanned and accessible within seconds and a few mouse clicks. This option requires the largest investment, but also provides the largest return.

There is no paper archive to manage and store, charts cannot be misfiled or lost, all charts can be found within seconds, and charts can be transferred to other practices instantaneously. Going forward, the practice can scan the small amount of paper it will receive from other practices, insurance companies, patients, etc.

Converting to an Electronic Medical Record System can be difficult, time consuming, and frustrating, but the records management part of the transition does not have to be.

Tags: Scanning, Medical Record Scanning, EMR, Healthcare, Electronic Medical Records

What Should Businesses Do With Their Existing Paper Records?

Posted by Matthew Petito on Wed, May 13, 2015 @ 03:23 PM

Now that the panic has subsided from the Brooklyn CitiStorage document warehouse fire (even though it shouldn’t) everyone is back in the out of sight, out of mind thinking as it relates to records management. Businesses need to consider what steps to take to create efficiency with their unique records process, and prevent a crisis like this from happening again. Documents in storage should be there only for retention purposes. Certain documents that will have an adverse effect on your business if destroyed should be in an electronic format and backed up.

There will always be documents that should be stored rather than scanned. It could be ten year old accounting documents, inactive medical records, closed legal files, terminated employee files… the list goes on and on. If these documents should ever become inaccessible or destroyed unintentionally, the business should be able to function properly without them. No business, other than one with thousands of dollars to spend, would even consider taking boxes of records that no one looks at out of a storage facility and convert them into electronic records that no one will look at.

But what does make sense is to convert records that are frequently retrieved and actively used in the office, such as active medical records, employee files, pending legal files, current accounting documents, active customer files, all documents that the business relies on to function. Electronic files are more secure, have audit trails, can limit accessibility, have easy to manage destruction dates, can be viewed by multiple people at different locations, have multiple backups, and are easier to manage than paper files.

Below are abstracts from a more detailed, day forward, application specific scanning service, with detailed posts to follow:

 

  • Proof of Delivery:

Everyone has had customers that do not want to pay for products or services that have been delivered to them, but with dozens or hundreds of deliveries per day, it can be a daunting task to track down signed delivery tickets to prove the delivery or service was completed. Instead of looking through thousands of delivery tickets, you can simply search for a specific delivery ticket by customer name, date, or other specific search criteria. Your company can even have the images integrated into your accounting software. Once the documents are electronic, you can instantly see who signed for the delivery or service and email it to their AP department, decreasing your receivables significantly.

 

  • Accounting Documents:

Unless your company has a fully automated accounts payable processing system (which it most certainly could), the accounting department most likely has the vendor payables and customer receivables in file cabinets organized alphabetically by month or year, depending on volume. Excluding very small accounting departments and businesses, most of these files are going to be accessed by multiple people and possibly from multiple locations. Being able to retrieve frequently accessed documents saves time searching for documents, increases efficiency, and eliminates issues related to lost or mis-filed invoices. Images can be hosted on a cloud based document management system, stored on internal servers, or integrated into the existing accounting software.

 

  • Human Resource Documents and Employee Files:

Human Resource departments are far more complicated than many people in business understand. They can be responsible for payroll, recruitment, benefits, employee relations, employee development, risk management, and many other specialized departments. With all this information being managed by HR, there is a lot of paper that can pile up quickly. Limiting the access to these documents by keeping them in file cabinets can cause inefficiencies that often go overlooked. Converting paper HR documents to easily accessible electronic images, allows remote and concurrent access, all within seconds, and with increased security and audit trails.

 

  • Medical Records:

With the transition to Electronic Medical Records in full swing, many practices are put in the situation where they have to make a decision on what to do with their paper medical records. They have a few options: they could do nothing, and use the EMR for billing and scheduling only, and continue to use the paper chart for patient notes, they could use both the EMR for day forward progress notes and the paper chart for the historical data, or they can scan the paper chart information into the EMR and centralize their patient care in one location.

Doing nothing does not make the most sense; you implemented the EMR for a reason. Using both can be a viable option for a while, but mistakes can be easily made when working from two forms of media. Medications, allergies, or immunizations can be in the EMR and not the paper record or vice versa, and if another practice or the patient calls looking for that information, someone at the practice might not think to check both the EMR and paper chart.

Scanning paper records into an EMR allows a smooth transition to comprehensive patient chart management. The images from the paper chart are easily viewed in the EMR, and everything day forward is input directly through the EMR interface. New patients are completely paperless. This solution is most appropriate for active patients with paper records that are frequently accessed.

Tags: Document Management, Records Management, Document Scanning, Medical Record Scanning, Brooklyn Storage Fire, Paper Records

The Recent Brooklyn Document Storage Warehouse Fire, and Many Other Tragedies, Point Out Why Digitizing Paper Documents Should Be Considered.

Posted by Matthew Petito on Thu, Feb 12, 2015 @ 04:41 PM

The massive fire last week in Brooklyn’s CitiStorage Document Storage warehouse was not the first time a document storage facility has been destroyed. To name a few, 1997 South Brunswick, NJ, USA, 2006 London, England, 2006 Ottawa, Canada, 2011 Aprilia, Italy, and 2014 Buenos Aires, Argentina.

With 1.1 Million Cubic Feet of records potentially destroyed at CitiStorage, including that of legal firms, financial intuitions, medical practices and hospitals (Mount Sinai Health System, New York-Presbyterian Hospital, North Shore-LIJ Health System and NYU Langone Medical Center), accounting firms, and both small and large businesses, the main question is and has been, why have these documents not been converted to electronic images?

Aside from the why haven’t records been converted, businesses also have to contemplate what would the cost be to recreate destroyed documents? What would be involved? And what if those records cannot be recreated? What would happen if original blueprints, medical records, legal cases, or financial documents are destroyed with no way of reproducing them? “It’s 2015, why isn’t this information electronic?” many people have asked.

Once records are digitized, companies will no longer have to pay for records management services related to document storage. After the documents are scanned, no more costs will be incurred. The electronic images can be on a hard drive, an internal network, or cloud based storage all allowing constant and instant access.Brooklyn Storage fire

On Sunday, 2/1, many New Yorkers woke up to thousands of pages of private and protected information floating along the Williamsburg waterfront and spewing through the air. Not only are the records that hundreds of businesses and government agencies depend on destroyed, the private and protected information of their customers and employee’s was put on full display. Many of these have names, addresses, account numbers, social security numbers, which can be used to easily steal someone’s identity.

 “About the possibility that confidential patient information might have been disclosed on a large scale as the wind scattered unburned records, Brian Conway, of the Greater New York Hospital Association, said, “There’s no reason to believe that’s a possibility.” Yet in one indication of the city’s concern, the disaster recovery contractors, in their neon yellow jackets, sealed off the entrance to the rocky jetty with yellow caution tape early Sunday and began to scoop documents out of the water with nets and shovels.” – NY Times.

The electronic images of scanned documents are more often of a higher quality than the original and much more secure. The entire CitiStorage warehouse could be scanned and stored on a few hard drives, which are much easier to protect, keep organized, and secured than thousands of boxes.

Tags: Paperless Office, Document Management, Records Management, Document Scanning, Document Imaging, Medical Record Scanning

Digitizing Medical Records? Here are some things to consider

Posted by Tom Doyle on Tue, Apr 13, 2010 @ 05:28 PM

President Obama has vowed the U.S. will digitize all medical records by 2014, and an economic stimulus package passed by Congress last year allocates $20 billion toward the process. So Hospitals, group medical practices and physicians who for the most part have shied away from transitioning to a full-fledged Electronic Medical Record (EMR), are now compelled to take action. While the stimulus dollars will help defray the cost of implementing the infrastructure to migrate to EMR, the question of how or whether or not to digitize all or a portion of the Medical Record archive needs careful consideration.

Digitizing the archive requires a fairly labor intensive process; preparing the charts by removing paper clips, staples, etc., scanning, assigning index values to the scanned images and importing the data to the EMR. The value of having patient historical information as part of the new EMR system is clear, but what if the charts are rarely if ever accessed? What if, as in the instance of specialty practices such as Cardiology, it's not known when or if a patient will ever need to be seen again? Retention requirements mandate that the chart be maintained for as long as 10 years from the last visit.

One solution that should be considered is storing the older, less frequently retrieved charts offsite, at a secure, climate controlled location, with a Certified Document Management partner like Shoreline Records Management. Our Medical Record Storage Services allow healthcare organizations the flexibility to store charts in an efficient, cost effective manner, yet have them digitized on demand. Once digitized, the electronic chart is transmitted securely and imported directly into the organizations EMR system. Requests are fulfilled 24 hours, 7 days a week, often in as little as two hours.

In the scenario of frequently retrieved charts such as Pediatrics, digitizing the entire archive is more likely. Our Medical Record scanning service center is equipped with several of the latest high speed document scanners capable of capturing images at a rate of over 120 pages per minute. Projects that would take months or even years if done in house with current staff can be done quickly and affordably, allowing the organization to access historical Patient information within the new EMR system.

Tags: Scanning, Medical Record Scanning, Healthcare

Document Management and the EMR - Conflicting Signals

Posted by Michael Thomas on Wed, Apr 07, 2010 @ 06:07 PM

There's a great post on the Hyland Software blog about how the Electronic Health Record needs to show more than just Patient Data. The post highlights some feedback from Last Month's HIMSS Conference, but the point is that Healthcare Organizations need to keep their eyes and ears open as they move forward with implementing Electronic Medical Record Systems.

It's alarming how many of these EMR Vendors are creating completely closed systems and relying on inexperienced technical resources to develop their "Document Management" portfolio. I would compare this to Ford Motor Company deciding that they were going to let Automotive Engineers design the LCD Screens in their newest Vehicles... It just doesn't make sense. The logical choice is to let the LCD Screen Makers do what they do best while Ford focuses on producing quality vehicles.

The Document Management has an entire industry behind it with focused, specialized software products that address issues such as integration, distributed capture, and technical details such as Image Caching, Security, and Audit Trails. Most of the EMR Vendors that I've been exposed to have a great core competency in managing Data relating to a Patient - meaning that they excel information that is naively electronic or input directly into their product. I've seen a trend, however, where the Document Management piece of the solution is much more of a bolt-on that doesn't work quite as nicely or provide the features of a true Enterprise Content Management System.

In the end, the best case scenario for many practices, clinics, and hospitals is to choose the EMR that is going to suit their Clinical Practice the best, while at the same time exploring a Document Management Solution that enables efficient Medical Record Scanning for Legacy Information and tight integration with various business and clinical applications, including the EMR. This strategy provides the best long-term prognosis for success by leveraging the strengths of each technology while not sacrificing future flexibility or scale.

What's been your experience? Share your thoughts in the comments!

Tags: Document Management, OnBase, Medical Record Scanning, EMR, Healthcare

3 Reasons to Outsource Your Document Scanning Project

Posted by Michael Thomas on Tue, Apr 06, 2010 @ 11:46 AM

As more and more companies implement Document Management Systems to help them deal with their growing paper problems, I wanted to share with you three reasons why you should think twice before jumping headfirst into Document Scanning using your own resources. Three Reasons to carefully consider outsourcing your document imaging requirements to a Professional Document Scanning Company are:


1. Lower Cost - Virtually all practices looking to begin scanning files will start by Purchasing a Document Scanner. The good news is that most of the scanners on the market today are of decent quality and offer most of the same features. Unfortunately, most of the document scanners that companies purchase fall into the Desktop or Workgroup Category, meaning that they can only scan about 1,000 Pages Per Day. If you're looking to process a significant volume of documents, you will need a High Volume Scanner, which can be significantly more expensive - even upwards of $20,000. In addition to having to buy more expensive equipment to address a significant Backfile Scanning project, you'll also need to dedicate Labor Resources to Pull Staples, Run the Scanner, and Index all of the scanned images. All of this costs money, and since Document Scanning is not within the core competency for most businesses, it takes more time to get through the process. Using an Professional Document Scanning Company lets you have all of your document scanned for a low price per image meaning that your costs are directly correlated to the number of documents to be converted, not the amount of time that it takes.


2. Improved Turnaround
- If you believe the old adage that people will make the work fill up the time, then Document Scanning is a sinkhole for employees looking to make the work last. It's difficult for many companies to judge the performance of a Document Scanning operation, and as a result many projects will take far longer as expected as staff blames the equipment, the quality of the paper, and nearly anything else they can find for the poor turnaround. An Outsourced Document Scanning Company will be responsible for delivering results in a designated timeframe, and it will be in their best interest to turnaround your job as quickly as possible because they don't get paid by the hour!


3. Improved Quality and Accountability - Like so many things in life, experience makes the difference in the Quality of Document Scanning results. Outsourcing your Document Scanning means that you'll have a team of professionals to ensure that your work is done correctly and that both image quality and data accuracy are given the attention that they deserve. In the event that there are issues with the completed project and you need something to be corrected, a Professional Document Scanning Company you will also be able to turn to your chosen vendor to help make things right.


Bottom line, think twice before you take on a large Document Scanning Project with your own equipment and resources. It may be more than you bargained for, and you may be able to save a lot of headaches by outsourcing the work to a team of document imaging professionals.

Tags: Paperless Office, Document Scanning, Document Imaging, Medical Record Scanning

How Much Does Medical Record Scanning Cost?

Posted by Michael Thomas on Thu, Apr 01, 2010 @ 12:05 PM

We talk a lot on our blog about Medical Record Scanning as more and more people are out there looking for services to support the nationwide rollout of EMR Solutions. It's common, however, that we get a request from someone looking for a rough idea of Medical Record Scanning Prices. It's an understandable question, as I know that I wouldn't want to sign up for anything without at least having an idea as to what the price was!

Well, I first need to preface this with the standard - your Mileage may vary, but depending on the complexity of your project, typical medical record scanning prices are between $.04 and $.12 Per Image. Some of the factors that will influence these prices are:

  • The amount of Document Preparation Required - If your Medical Records have a lot of Staples, Clips, and fastners, or if you need files to be sorted based on sections and sub-sections of the chart, you'll likely be toward the higher end of the pricing scale.
  • The Volume of Medical Records to be Converted - Document Scanning Services are one of those things where it definitely pays to buy in Bulk. Our Price per page builds in all of the setup and administrative costs, and those are offset by having a higher number of pages to convert.
  • The Indexing Criteria Required - If you need to search for Patient Information based on First Name, Last Name, and Medical Record ID Number, that's pretty standard. If, however, you want to add additional information to your images - Phone Number, Addresses, etc. - it will require more time, and ultimately will affect the price per image. (Keep in Mind that if you already have a EMR or Database system that we can use to lookup additional data based on Medial Record ID Number, you can add as much or as little of this information as you'd like.
If you're looking to get a quote for your Medical Record Scanning project, please take the time to get an estimate based on your specific requirements. We'll be glad to provide you with an estimate, and we can even provide you with a sample of our services to let you see how easy our process is and so that you can get a feel for the quality of our work.

Tags: Document Scanning, Medical Record Scanning, Healthcare

Bulk Document Scanning - Make it someone else's problem!

Posted by Michael Thomas on Mon, Mar 29, 2010 @ 02:32 PM
If you're staring at a mountain of paper and not sure where to start, take a deep breath and read on. Bulk Document Scanning is easier than you think. When it comes to converting significant volumes of paper, the easiest, most cost effective option is often to outsource it to a professional document scanning company like Shoreline Records Management.

Bulk Document Scanning is not like most scanning projects, where one or two files need to be captured at a time, and therefore usually calls for a different approach. The key to scanning significant amounts of paper is to ensure that there is a repeatable, high quality process in place to ensure that all of the documents are scanned and indexed accurately so that they can be retrieved when needed. This often takes not only high-speed scanning equipment, but also a very specialized process involving teams of people who specialize in each facet of Bulk Document Scanning Projects incuding:

Document Preparation - Pulling Staples and Sorting through Boxes and Boxes of Paper is a necessary component of Bulk Document Scanning projects. That's why Shoreline has a team of Document Preparation Specialists who work to ensure that your documents are cared for, sorted, and classified correctly so that you can find your content when you need it.

Document Scanning - Trying to Scan Tens of Thousands of Pages through most office scanners is a certain recipe for a service call. Shoreline uses Production Document Scanners to ensure that capturing tens of thousands of pages per day is a breeze. Our operation is engineered for high volume scanning and we use industry leading technology to ensure the best possible image quality at the same time.

Indexing - To effectively index a bulk document scanning project requires a team of dedicated index operators. Documents must be accurately indexed to ensure that files can be found when searched for.

Quality Control - Ensuring that images are clearly scanned and accurately indexed is essential to a Bulk Document Scanning Project. Outsourcing means that there is an entire team focused on document scanning while you stay focused on your business.

If you're staring at a lot of paper and looking for the quickest, most cost-effective way to convert it to digital images, consider Outsourcing. Bulk Document Scanning is so much easier when it's someone else's problem!

Tags: Document Scanning, Document Imaging, Medical Record Scanning

Backfile Scanning Takes a Step Forward

Posted by Michael Thomas on Wed, Mar 24, 2010 @ 02:23 PM
Backfile Scanning is becoming increasingly important for companies who begin Document Imaging projects. Most of the time, these projects start innocently enough, with a company looking to take advantage of the many benefits that electronic document management has to offer - reduced costs, improved efficiency, increased compliance, etc. Soon after though, the glamorous vision of the paperless office is quickly replaced by a harsh reality - someone has to do all the work!
 
Document ScanningWhether you're scanning medical charts, converting loan files, or processing applications, Document Imaging is never as simple as just putting some pages through a scanner. This is especially true when dealing with a backfile scanning project. In order to start the process, someone needs to go through the files and remove all of the staples, repair dog-eared corners, tape small pages, and partake in other fun paper-processing tasks. In addition, the files must be sorted correctly to ensure that the structure of the files will be meaningful and useful when the files make their way to the document imaging system. This process involves inserting barcoded separator pages or stacking the pages in a specific way to allow the system to recognize one document from another. Quite often people don't realize that this manual document preparation work is required before you've even put the first page through the scanner.

After the preparation is done, the files must then go through the scanner and be captured as images. This too seems easy enough, except that most document scanners are not designed to handle thousands or tens of thousands of pages in a day. High Volume scanning requires specialized equipment that can sometimes cost $20,000 or more.
If you've made it this far into the process, you now will need to accurately Index your documents by tagging the files with appropriate metadata, or keywords, and then implement a process for Quality Control of scanned documents.
The good news is that the document imaging project isn't the problem. The problem is that Backfile Scanning is a lot of work, and most of the time is better suited to be an outsourced initiative. By outsourcing your backfile scanning, you can keep your staff focused on more productive tasks while a team of professionals handles your scanning needs. By using Outsourced Scanning Services to handle your backfile, all that you're responsible for is a fixed price per image. The service provider will be responsible for handling the document preparation, scanning, indexing and quality control and would provide you with images via CD, DVD or FTP.

To find out more about our backfile scanning services, check out our Document Scanning Services section and contact us to see how we can help with your specific requirements.

Tags: Document Scanning, Document Imaging, Medical Record Scanning

Medical Record Scanning gets New Meaning

Posted by Michael Thomas on Tue, Mar 23, 2010 @ 06:39 AM

The team at CNN.com recently highlighted how a Bronx Healthcare clinic is using a new type of Optical Recognition to retrieve Medical Records, and it’s not quite what you’d think of when you bring up Medical Record Scanning . The clinic – Urban Health Plan – is using Scans of a Patient’s Iris (the unique part of the eye) to accurately locate and match patient records. The article cites many examples of why this technology is so useful, particularly in a clinic that boasts 103 Patients with the name Jose Rodriguez!

As this new, innovative technology begins to replace the old check-in process at this particular clinic, there must also be consideration given to another type of Medical Record Scanning – the physical patient chart. With a flurry of new technology being created, marketed, and sold to Medical Practices across the country, document scanning for the paper-based chart is becoming that much more important. While the CNN article doesn’t “Sight” (Sic) whether or not Urban Health Plans is retrieving a physical paper-based chart or using an Electronic Medical Record System, There is certainly another level of efficiency that can be achieved by having their Iris-Based Scan Technology retrieve an electronic copy of the Patient Chart directly to the point of care.

While Shoreline's primary focus is on helping practices convert their Paper-Based Charts to Digital Images through Medical Record Scanning, I must applaud Urban Health Plans for their innovative and effective use of emerging technology. As a technologist (and a Healthcare Consumer) I believe that anything that can help reduce errors, eliminate costs, and improve the quality of care is a step in the right direction. Kudos!

For More Information, Check Out:

Urban Health Plan

CNN.com - "At Bronx Clinic, The eyes are windows to Medical Records"

Shoreline Records Management - Medical Record Scanning 

Tags: Medical Record Scanning, EMR, Healthcare