Home Forums Discussions General Discussion Keeping hard copies of chart notes?

Hi everyone, I'm new to the forum here, and have been using AC a little over 6 months now. I've been printing out my AC chart notes and filing them in hard copies of charts since I've been using it, mostly out of "electronic storage phobia" I suppose. While it is nice to have a printed reference in the chart for some uses, it seems to be a waste of paper. I will continue to maintain hard charts for labs and faxes and everything else that I'm not up to scanning into AC quite yet, but feel like I should stop printing out notes. How many others are in between cyber world and hard charts like this and do you have any recommendations for what is easiest? Do most people scan everything into AC and not have hard charts at all anymore?

I don't scan in labs, xrays.

I don't print out messages from within amazing charts (although they are saved to the electronic chart).

Currently I print out progress notes using an autoduplexing printer.

Eventually I will go paperless, but only after this whole EMR thing is standardized more.

I scan in all labs, docs, letters, but still hold the originals in the chart. I also duplex print out the notes, so I can look back at the papers while in the room w the patient. I find it hard to look back using the past visit section, as it is not analog enough for me, and I would have to leave the room to access the computer. I am hard-wired in my office and am not using tablets. Also being a pediatrician, my laptops would be destroyed if I had them in the rooms, so I use them at "stations" strategically placed in the hallways between examination rooms. 1 station per every 2 rooms used. This gives me flexibility to move up and down the hall and have a screen and a printer close by. I exit the room after the Exams, then return w/ the Rx and Care Plan and any other handouts I need, plus it gives the pts a chance to redress and prepare for the exit instructions.

Fellows...take the plunge! As someone who practiced medicine without a computer for over 15 years and then printed out notes for almost 5 years, it has been very nice to move towards being completely paperless. I now scan in everything and am about 3/4 finished scanning in old charts. Once I got used to not flipping through paper charts, I now love having the imported items categorized and right in front of me and am ticked off when I do have to get the paper chart and thumb through it. I complete every note in the room in front of the patient and, by the time they make it to the check out desk, their scripts have been faxed or printed, their instructions printed and their appointments and tests are already being processed by the front desk. The patients are impressed with my apparent efficiency!
No matter what the EMR situation will end up being, your data will be in an easily transmittable form. Which brings up another point. No more dragging out the paper chart, sifting through reports or notes that I want faxed to consultants. Simply "print" the scanned report to the fax machine and it is on its way. For patients who desire their records be transferred, a nifty little program called PDF Direct (free) can collate everything in their chart, give you a page count and burn it to a CD.
So, in summary, I highly recommend you move quickly to paperless. You know you will have to do it in some form or another in the very near future...may as well do it while you are getting used to the magic of AC! Just make sure you have several back up plans/methods.

Leslie

Well said Leslie!
I'm going to second your motion for everyone to dispose of their paper charts.

Bert did it the best way, he STARTED using AC and therefore has never required to transfer paper records.

I did it the hardest way, I STARTED using paper and converted to AC. In 4 years of being solo FP, it's the second best thing I ever did for the business of my practice (the best was deciding to go solo).

To my senior colleagues who only had the option of using paper, please let go of the paper.

After 20 years of paper charts and an entire room full of file cabinets, the amount of time we wasted physically moving peices of paper from one workstation to another was driving me nuts. I hope that after a year of this that we have very few paper files left. Our current rule is that any paper chart that has been pulled from the cabinet for any reason does not get refiled, it gets scanned into AC and then shredded. That goes for incoming labs, reports, anything. I agree with Leslie, for the majority of patient visits the note is finished with orders, prescriptions and instructions all printed and waiting at the front by the time they walk to checkout. My charting time at the end of the day is maybe a fourth of what it used to be. I am not very good at coding the visit and haven't worked out what to do with that, so I still send a printed charge slip with the patient to check out with.
I am loving it.

Staples hates us. We use about a rheem of paper every other month. We would simply print nothing if it weren't for government paperwork like WIC forms or prior authorizations. Even the new paperwork is sent wirelessly to our computer.

All faxes, labs, x-rays come directly into the computer. We haven't printed a progress note since we opened. When we send records, we either fax them from the computer or if the patient needs it directly, they get it on CD.

But, if you only back up to a flash drive, then print ALL your progress notes!

The key is paperless and backups. Lots of backups.

But, if you aren't comfortable and you will lose sleep, then by all means, keep paper copies.

I too still use a paper superbill because I use a different PM program. This superbill also serves as the patient's receipt. I am hopeful that V5 will allow me to code and transmit this easily as well.

Leslie

I'm still afraid to let go...how do you handle the new patient info, history, HIPPA release, etc. Do you have them fill out paper and then scan and shred?

I use a service called Phreesia pads - has all the above in it and auto makes a PDF file on the receptionist computer - then imports. It was free, now $50.00 per year. If you have a reasonably sized office they give you 2 free touch pads - has a basic Cc, HPI, Past medical, surgical, family and social history - along with signature for consent and HIPAA. I really like it (no financial interest) and if you have questions feel free to PM me off the list and I can tell you who I work with, etc. They are planning on making interface for Version 5 to make it auto download the demographics from your scheduler for when pt. arrives,etc.

Yes, Peggy, my patients still use paper H&P, HIPPAs, etc. We then scan and shred. As an internist, I do not think most of my patient population would cotton to having to use a computer to complete these forms. For those that can, we email or fax the forms to them ahead of time and then give them the option of bringing in paper copies or faxing or emailing them back. As I am not real fond of emailing, I usually ask them to fax if they have the means. Some of my patients will keep a copy of their H&P on their computer and then update it every year when they come for their annual exam. It also serves as a record for them to refer to at other times should they need to.

Leslie

We have the Phreesia pads as well. Actually, I think Steven turned me onto them. The patients love them. We don't, however, use them at every visit as Phreesia wants us too. We only use them at the initial visit.

Great conversation here, thanks for all the feedback. I'm interested in the Phreesia pads, can you customize any of the intake forms if there are questions you want answered that aren't there already? It seems like a great bridge into the cyberworld of paperless.

Leslie, for patients who email intake forms back do you somehow import them into Amazing Charts, or are they manually inputted by front desk, or scanned?

Serena
Naturopathic Family Practice
Seattle, WA

Serena,

When you first sign up with Phreesia, they will ask you if you have any forms you want put into the system. For instance, we have all of our demographic and HIPAA forms right in there, and they sign them electronically. You can also keep tweaking it by calling them. The amazing thing that Stephen didn't talk about is after you talk to them on the phone, they send a tech out in about three to five days to set everything up as it is wireless.

Deborah,
I do the same thing, since we have a separate PM program.
The only paper that I take into the room in the encounter form.

Peggy,
We have people fill out the paper version of consent to treat forms, and then scan them in and shred the piece of paper.

Serena,

When we receive an email, we "print" it to the Paperport desktop and import it from there.

Leslie

Leslie,
we do a similar thing with emails. I print them to .PDF format and drag into the Import Items folder.

AND.... you should be able to drag the email right from Outlook into AC. Then, it is there if you want to reply, forward, etc. and you have the original. I would experiment before making it your one way of doing it. Works for me, though.

Bert,

Are you saying that I can do a simple click and drag to move email from Outlook to AC?

Frank,

Yes. You can drag right there. It can be a bit tricky depending on whether you are using Exchange Server or not. In that instance, the email is actually stored on the server and the client Outlook is not. So, either way, you may find you have to drag it to the desktop first. I tend to keep one folder on the desktop called "AC Email" and drag it there first, then drag it into imported items.

If you open the email that is in the ImportedItems and it opens in Notepad and looks like a foreign language, then right click on it, choose properties and change it to open with Outlook. Then, they will all open with Outlook.