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Meaningful Use Doesn’t Address ‘Hybrid’ Transition Period

Posted on July 7, 2011 I Written By

Some 10 years ago, when I first started covering health IT, a lot of the talk was about the “modular” approach to EMR adoption, i.e., put in a piece at a time during a transition period. Much of that had to do with the state of technology at the tail end of the dot-com bubble, when companies developed applications to address one small problem, often in the hopes of getting a larger firm to shell out big bucks for their idea. (Wouldn’t you know, that’s how many vendors, most notably GE Healthcare, put together end-to-end enterprise systems.)

Implicit in any step-by-step transition to EMRs was the idea that there would be an interim period where providers would have to run dual electronic and paper systems. It’s a notion that’s always been with us, but how many people still think of it?

I got a reminder this afternoon when I spoke to Ken Rubin, Iron Mountain‘s senior VP and GM for healthcare, who was talking about results of a new survey on progress toward meaningful use. (I was ostensibly doing that interview for InformationWeek Healthcare, so look there tomorrow for coverage. Here, I just want to talk about one aspect of the conversation.) Rubin noted that there seems to be a sort of “no-man’s land” between the paper and digital. “I don’t see a real, well-defined way of dealing with the hybrid world,” when hospitals and medical systems are switching to EMRs while still retaining old paper records.

Obviously, Iron Mountain would like to sell some scanning, data management and shredding services to healthcare organizations, but Rubin has a point. The rules for meaningful use Stage 1 don’t say a thing about what you’re supposed to do with existing paper files, and it doesn’t appear that Stage 2 will address that issue either.

Do you scan all the old files immediately, or wait until each patient’s next visit, then chart electronically going forward? What do you do with the files of inactive patients? Do you archive records in house or offsite? Do you still need rows of files taking up valuable square footage that could be put to better use? What do you do with clerical staff?  Do file clerks become managers of electronic health information, or do you need to replace those people with others trained in HIM?

Rubin noted that this limbo often works against organizations trying to overcome physician resistance to change. “The faster you can get to the other side, the faster you’ll get physician adoption,” he said.

That all makes good sense to me. CIOs and practice managers, what do you think? Have you addressed hybrid workflow during this transition period, or is the siren call of federal dollars for meaningful use too strong?


Scanning and Importing Paper Charts Into an EMR

Posted on April 7, 2008 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As many of you know, I love getting comments on my blog. Plus, comments on my blog often ask very good questions that I prefer to just answer as a separate blog post. I’ve considered a few times trying to integrate something that would allow people to ask questions that I could then answer, but I’ve never found just the right solution. Until then, just leave a comment and I’ll reply as best I can.

The following quotes are from a comment Sean made on my Choosing an EMR or EHR post.


I’m not sure how he got my name as Eric since it’s not Eric. Possibly he was confusing it with my post about Eric Schmidt’s Google Health Announcement at HIMSS. I really don’t mind what you call me as long as you leave insightful comments and questions.

Thanks for the informative blog. I hope others have found it as interesting as I have.

Thanks. I’ll pay you later for the compliment.

I have a question about EMR implementation & you may be able to provide a good answer: When a practice adopts an EMR solution, what is the process by which all of the existing files get scanned & imported to the EMR? Do practices send their files to an outsourced (and presumably HIPAA compliant) scanning company? Or do they buy a scanner & have the staff or temps scan them in bulk? Or do they scan patient files as those patients come to the office?

Do you have any insights here? Seems like a big part of the process, but I’m having trouble finding information about it.

Of course, the obvious answer to your question is Yes! The reality is that every method you describe above has been done. I personally recommend sending the files to an outsourced HIPAA compliant scanning company. It’s a pretty smooth process to send them out and the company can often index them in such a way that you can access those files quickly if needed. I say I prefer this way, because we found that in the majority of cases there wasn’t a need to look back at the paper charts. In the beginning of our EMR use, we would pull the chart for each patient. After doing this for a short period, our clinicians found that more often than not, they didn’t have a need to see the paper chart. So, we decided to stop pulling the charts unless a clinician made a specific request.

I can imagine that this may not be realistic for many people. My clinic works with a younger population which don’t usually have an extensive medical history. However, our experience provides a good insight for other practices. Take a second to notice how often you look into the paper chart. How often do you need the information from past visits found in the paper chart? If you are like us and rarely needed the past history, then why waste your time pulling charts and scanning them individually?

For those that feel they need to see a past chart, you might consider my previous post about “Thinning Out the Chart for Scanning to an EMR.” The idea is just pulling out the relevant information that needs to be inputed into the EMR. The rest of the information can remain in the paper chart.

If you decide to start scanning the charts in yourself, I think it’s a good idea to scan as you go. I don’t expect that most offices have an abundance of people that are just sitting around needing something to do (ie. scanning). Scanning is a tedious process and it’s better to bite it off in little chunks. Then, once you’ve made a dent into the past charts, you can consider doing a bulk scan or sending it out to a third party scanner to clean things out.

I think the key milestone to achieve with your EMR is to reach a point where you no longer have need of a paper chart. This really takes a change of perspective for most people. It’s so easy to just drop a paper into a chart. Your medical records staff are probably trained well enough to create charts in their sleep. Teaching them to scan all the paper into your EMR takes focus and effort. However, with a little work it becomes second nature and people won’t remember what it was like to have paper charts.

Thanks very much in advance.

Thanks for stopping by EMR and HIPAA and asking some very good questions. A blog becomes much more interesting when their is interaction with the end users.