As I mentioned in my previous post, I decided to try out some videos related to EMR, EHR and healthcare IT. I’m still not sure if it’s a good idea or not, but I created 4 videos in my inaugural experience. I just used a simple web cam to create the videos since I was also streaming it live on uStream. Maybe next time I’ll set up my HD camera and do it that way.

Either way, here’s one of the videos I recorded where I respond to the following question:
Once converting paper to digital in an EMR, how long do providers plan to keep their charts?

Full Dislaimer: I’m not a lawyer, so be sure to consult a lawyer for legal advice:-)

If you like the video, be sure to check out one of the other videos I posted on EMR and EHR about EMR Data Sharing.

Let me know what you think of the videos. Should I do more? Should my face not be on video ever again? Are there other questions you’d like me to answer?

One of EMR and HIPAA readers, John Meewes, was reading some of the comments on my previous post, “Paper Chart Disposal After Implementing an EMR” and wanted to provide a scanning companies perspective on what he’s seeing in the market. The following is his guest blog post on the subject.

Discretionary scanning, hiring temporary help, and re-purposing office
staff to scan patient charts has been a growing trend.

While the costs associated with these practices may at first glance seem
lower, there are hidden costs and liabilities that far outweigh the
expected savings.

When selecting a scanner, the first number potential buyers see is the
“Pages per Minute” (ppm). This is the number of sheets that the scanner
can read under optimum conditions (and usually at lower resolution and
page size). The number usually not published or ignored is the daily
duty cycle – often just several thousand pages per day.

In real world settings, the actual throughput is less than 1/4 of the
published PPM. Jams, indexing, and software glitches all slow the
process. Equipment maintenance, software installation, training, and
employee turnover further add to the time spent on the scanning project.

As labor costs (which are a function of throughput) increase fourfold or
more, the ROI model that may have initially shown cost savings with a
“do it yourself” project may no longer support that decision.

Most importantly, though, is the liability physicians face for
improperly scanned charts. Transient help is cheap, but they have no
responsibility to monitor quality, ensure that records are properly
filed & attached to EMR, or to ensure that misplaced records are found.
We even worked with a physician who had temporary help literally
throwing charts away to create the illusion of higher productivity.

Physicians are required by law to maintain a medical record for each
patient which completely and accurately documents the person’s
evaluation and treatment. The failure to maintain a record for each
patient constitutes professional misconduct. A missing chart could
have serious consequences on the provider’s ability to defend themselves
in a malpractice claim. If you can’t produce the documentation, then
your version of the events will be suspect.

Reputable service bureaus have quality and auditing measures in place to
ensure accurate and complete conversion of paper charts. While the
upfront costs may seem higher, the peace of mind and longer term savings
are worthy of consideration.

John Meewes, President of National Scanning. National Scanning offers secure nationwide HIPAA compliant patient chart scanning services and EMR implementation consultation. www.nationalscanning.com – Patient Chart Scanning Services (888) 211-1797

I’ve previously written about chart disposal after an EMR implementation and the concept of “thinning your paper chart for scanning into an EMR.” Because of those posts, one reader asked me about feedback on a list of what things should be included in the “thinned” paper chart.

Of course, my first reaction was to tell them to ask the doctors. Each doctor/specialty/clinic is unique and so every one of those would have their own list of what they thought was important. However, I also said I’d post their list on here for people to take a look at and provide feedback on things that shouldn’t be on the list or things that might be missing from this list. So, check out this list and I’d love to hear feedback on it in the comments:

Paper Chart to EMR Scanning List (in no particular order):
Birth records, Nursery, NICU, State Screen, Type/cross.
Growth Charts front and back.
Immunization record (multiples may exist, scan all).
Master Problem List.
Chronic/incidental/PRN medications.
Allergies/sensitivities.
All prior well child checks.
School/Scout/etc PE’s.
All acute visits if chronically ill, otherwise do not include uncomplicated CCD.
All special evaluations (ADHD/Feeding/Nutrition etc done in house).
All referral and specialists’ consults/findings.
Family History if known. Adoption may prohibit this.
City water vs well water.
Lab reports – baselines and all if chronic medical issues.
All diagnostic imaging reports.
Insurance history.
Demographic sheet/all address changes.
All legal documents – custody/state/adoption/POA/living will etc.

A look at this list makes me think about what types of things might be useful when exchanging patient records electronically. Seems like the concept of thinning the chart and exchanging data might be worth considering together.

We now interrupt all this HITECH act EHR stimulus money talk for our regularly scheduled program.

If you are looking at implementing EHR, then you better become familiar with a nice high quality scanner. Don’t believe anyone who tells you that they are paperless. Sure, many don’t store paper, but even the very best EMR or EHR implementation has loads of paper that needs to be scanned.

Still don’t believe me, then how do you plan on handling a new patient who brings in a stack of paper records from their old doctor. I’ll leave the rest of the list of possible paper for another day. Suffice it to say that you’ll NEED a high quality scanner that can handle high volume.

When we first implemented we used a nice little all in one scanner. Worked well, except we literally burnt it out after less than a month of scanning.

After that we finally ponied up the money and bought some high quality, high volume fujitsu scanners. 4 years later we’re still scanning with no end in sight. We do have to do regular cleaning (about 5 minutes max) to clean off all the ink that gets on the feeder. Otherwise, these babies are the best I’ve seen. Here’s links to the 2 models fujitsu currently offers.

Fujitsu fi-6130 Duplex Scanner

Fujitsu FI-6230 Clr Duplex 40PPM/30PPM USB
Flat bed and ADF feeder:

One has a flat bed for those hard to feed scan items (ie. prescriptions) and the other is just the feeder for the high volume scanning.  Some may think it’s a little expensive for a scanner, but it’s worth it.

I’ll be updating my list of EMR and EHR technology with items like the scanners above. Many people have asked me which scanners are best, which computers are best, what about tablets, fax servers, etc, etc. Now you can just check out my list of software, tablets, computers, fax servers, scanners, printers, etc and see some recommended items to help your office.