First, a "meta" comment.... this board was most busy and valuable in the early days when people were picking an EMR and learning how to use and live with AC. It continued to serve a purpose, but with some decreased activity and urgency in recent years. Now the board and this group demonstrates its value once again, as some of us approach the end of our careers. Even if you are not "there" yet, it is helpful to think about how you will deal with records post-retirement or after moving on to some other job or EMR.
To summarize some of the above comments... we need to preserve medical records for a variety of reasons. After we are done with them, others use them in a variety of ways. After retirement (and I will use that word as a shorthand for "not using AC to see patients anymore", in all its forms), we want to satisfy the needs of our patients and their new doctors. We also have legal responsibilities that we must meet. We want to do all of that with a modicum of effort, time and expense.
We need to have a complete record on each patient for legal purposes for a given number of years. That number I believe varies state to state, but is usually 7-10 years. There is no room for discussion on this point, though there might be room for some discussion as to what constitutes the "full" record. For our purposes, in general, the record consists of the two main parts of AC, the notes/encounters and imported items. If a lawyer asks for the patient's record, I think you must be able to provide all of that.
We also want to be able to provide a record to assist in follow-up care of the patient. There is much more individual variation here. Sometimes the new doc just wants the latest note. Maybe most recent bloodwork and EKG. Maybe, as Bert says, they don't look at any of it. Others may want more, like the CBC's from the last decade, or the last colonoscopy report from 8 years ago.
Then there is variation based on the retiring doc. Some may be willing to spend the time to curate each individual chart, or create a summary. That may be a great service to his patients who are moving on. It is certainly time-consuming and may provide more than the receiving doc will use. Others just send the entire record, which may or may not even be examined.
This also may vary based on timing. In the first months after you retire, you will get lots of requests and may be willing to make the commitment to sending something useful. Three to five years later, the situation changes.
In my view, we need a complete record for legal purposes, and we need the ability to store and send the records in a form that will be useful to the referring doc and a minimal burden to the retiree (or his/her staff or survivors).
James' approach serves all functions well. Legally you are covered. The doc who sees the patient and wants little or nothing from the record gets it all, and can easily file and store the pdf.
If they want the most recent note and labs, it is easy to find each of them. Notes are printed chronologically, and as James describes it, so are the imported items). So the most recent note is presumably at the top of the pdf. If you need a recent CBC, no need to scroll through hundreds of pages ... it will be at (or near) the front of the imported items since it is recent. If you want an old chest x ray or colonoscopy, you can search the pdf for those terms, and find them easily.
From our side.... it does not get much easier than this. You are storing a batch of pdfs that you can put on a couple hard drives in various places, or stored in the cloud. No need to worry about a computer going bad or a program going out of date or a company out of business. You can't lose the files, can easily store them, never lose them, and can easily transmit them on a hard drive/cd/thumb drive/fax or via encrypted email.
Lots of ways to do this, but this is what makes the most sense to me.
Last edited by JBS; 02/01/2023 12:46 PM.
