Transitioning from Paper to

Electronic Health Records (EHR)

Ricky Dyson, Clinic Manager, of Riverton Family Health Center, Riverton, Utah describes how their transition team created a smooth transition from paper to electronic health records.

Our doctors understand the real cost of scanning (in excess of $60,000.00 for our five-provider clinic if we did it in house). The cost would be more if we outsourced and we would have the data on a CD that may not be accessible in the EHR. Because of that, they are thoughtful in choosing which items to be scanned.

They also understand that scanned data are not accessible in a discrete form—instead, these documents become digital pictures that are not searchable. Scanning works for EKGs, letters from specialists, or pathology reports. Items that should be tracked or trended such as lab results, growth charts, or obstetrical information should be entered in discrete fields in the EHR.

We have found that after one visit, the paper chart can be archived because everything of importance has been either entered or scanned. The paper chart is still available if it is needed, but is not routinely pulled for the next visit.

We performed a “hard archive” prior to implementation. We normally archive charts that haven’t been used for two years. Rather than two years, we archived charts that haven’t been used for one year. This accomplished four things:

  • Cleared space,
  • Removed the inclination to scan old charts,
  • Prepared the staff psychologically so they did not go crazy at the sight of disappearing paper, and
  • Allowed the records staff to organize the archive area in preparation for daily scanning and archiving.

The transition team designed the following process:

  • Prior to implementation of the EHR, clinical staff and providers agree on which data from the paper chart data must be entered into the EHR system (e.g., problem list, medication list, labs).
  • The paper chart is pulled (as usual) before appointment time and medical assistants enter the agreed-upon data—in discrete fields—into the EHR.
  • The medical assistants enter vital signs and other data requested by the provider prior to the encounter.
  • The paper chart goes with the patient into the exam room during the first visit in case the provider needs information that has not been entered.
  • During the visit the provider enters current information about the exam and treatment plan into the EHR.
  • After the encounter, the provider quickly reviews the chart and flags pages to be scanned into the EHR, in addition to discrete data that were already entered.
  • Once flagging is finished, the provider writes an “A” (for Archive) on the front of the paper chart.
  • The paper chart is delivered to the records clerk who scans the required pages and archives the paper chart in the storage area in the basement of the clinic.

One month later:

  • All of the remaining paper charts are archived. Rather than transporting boxes of charts to the basement daily, only the charts needed for the next day are retrieved
  • One provider is going the extra mile. He retrieves a few charts for his long-term patients each day, even if they are not coming in. The data is entered, scanning is done, and the chart is archived.

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