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We are in the process of implementing AC, and I am going to post things as we go under "lessons learned." I am going to forget soon, and they may help someone else starting out...

We initially assumed we would be culling old records to be scanned in. Then, someone thought "why bother?" Imported files arenot all that useful; they are not well indexed, you can't search on them, and they take up a lot of disk space. The paper chart space is not going to get any bigger, and will gradually shrink as patients move off, and the charts age and can be destroyed. We are not in critical need of the space. So, no scanning in old charts. Just go look at them if you need them.

Some things come in that do need to be imported. We bought a $500 scanner, only to find it did not do TWAIN files. We sent it back. Instead, we are using UpDox, and if something needs to be imported, we will fax it to ourselves. UpDox makes it very easy to import, sign off, and notify the patient via the patient portal if necessary. Although we have to pay for faxes, it is going to be cheaper than having to have an employee scanning, importing, etc. We plan to use significant "import discipline"; the issue is the number of imported files, and the ability to do remote backups. We plan to import only those things that have a direct impact on our ability to deliver care; not everything that anyone sends us unrequested.

UpDox is proving to be an extremely useful tool.

Our office took a different approach about our old paper records and incoming faxes.

We did buy a Fujitsu SnapScan 500; it is consistently rated as one of the fastest and most reliable sub $500 scanners. It scans both sides, makes the scan into a PDF, and comes with the standard version of Adobe Acrobat and can convert the scanned document into a searchable PDF.

It is true that it is not a TWAIN scanner, so you can't scan directly into AC. But we didn't want all of our old data in AC anyway. We scan each old record as a PDF, and file it by patient name & birthdate on our server, so any networked computer can access the full old chart. Then we shred the old chart (there is substantial case law now that scanned docs are legally admissible). As a result, we no longer need our air-conditoned off-site storage area for retired charts, saving several hundred dollars a month.

We get most of our reports by fax, and since they are received on a Mac, the Mac fax-modem automatically saves the fax document as a PDF. We found that buying a refurb Macmini from Apple for $300 and networking it as a fax-server was cheaper and more efficient than a network stand-alone fax machine. A staff member reviews the incoming faxes and either deletes it, prints it or imports the fax into AC for sign-off by the doctor.

After reading comments from the expert users on the board, it looks like Updox and PaperPort are quite good options as well.

"why bother" .. I assume you have no off site storage which in our case was about $250 per month and a dirty, spider infested adventure every time you needed to retrieve records for yourself or for a records request. And forget about someone actually spending a weekend sorting through the shed, finding the Adult records that were 10 years old and could go to the shredder. (Peds are age 18 plus 10 years! think about it!)
The in office cost was a space (3 Docs) of almost 400 square feet at $1.50 per square foot per month. Total storage floor space was $900 per month. $10,800 for the year. Not including Labor to go feed the spiders! And it goes on year after year for at least 10 years. You can scan them in during "spare time" for just the cost of the disk space and one or two worn out scanners.
I would revisit this issue periodically and when you have the time, scan and shred!

And I proof read this and still need to append: We don't scan old records into Amazing charts, we just store them as .pdf's on the server in another place using some free copy software that came with a canon scanner. The software is "capture perfect"

The pdf storage is an great idea, and one that we may want to explore. We do have off site storage for inactive charts, but thanks to the cold, without the spiders. I'd love to get rid of it, but the personnel time to scan seems daunting. We're new at this, and still somewhat overwhelmed. I will revisit this issue for sure once we can catch our breath. Thanks.

Scanning in old records is a great summer job for some kid who actually would like to work. I agree with Martin. Scan in as much as you can. I have been scanning old records in now for almost 2 years. All of the long-term active patients are in and have been for a long time. We are now working on the "short-term patients" (without meaning to sound indelicate, these are patients 85 and older) but are doing it as we get a chance. Everything new that comes in is electronic so, even without all of their old charts scanned, I am still pretty much able to work without their paper charts. The inactive charts are stored in my ample crawl space under my building and hopefully the sump pump will not fail. Every January we get down there and cull out the records that are now old enough to shred.

What are the requirements in your state for records retention? Ours are shredded after 7 years, and the charts go to the catacombs after 3 years of inactivity as they are now considered "new patients" and the old data is not all that useful except for medicolegal reasons.

In Indiana it is 7 years also. We "catacomb" a chart when a patient transfers records, expires, or has not been here in 3 years. I aggressively inactivate charts in AC so that when I do a search (which I can no longer do because it does not work anymore...I am still not on V5), I do not pick up a lot of patients I know will not be coming in.

I thought it was Federal law that mandated 10 years now (actually from Jan. '09). Is it only State laws?

You would think this would be an area about which the law is clear, but apparently it is not. There is federal law which applies (part of HIPPA and Medicare participation) as well as statutes which vary by state. Ask five lawyers for an opinion and you get six answers. What I have most commonly heard is "technically 7 years is enough, but I would recommend 10".
I am obsessive about keeping old records. Not so much for legal reasons; just because I am obsessive. So when we switched to AC, I decided to scan all of them. I hired a student, basically for minimum wage, and he is now finishing the job. Roughly 16,000 charts which filled a wall of shelves, several file cabinets, and an assortment of boxes squirreled away now occupy about 20 gigs on a hard drive. Call me nuts (and my family and staff does, at least on this issue) but I like having it all. It is helpful for patient care, and frankly satisfying to recycle all that paper, save all that space, and still have all the information readily accessible.
No more "catacombs", crawling into basements or closets, sweeping away cobwebs, lugging heavy boxes around, etc. And all of those things do have some cost, which partially balances those of scanning.

Maybe I'll change my mind. From the beginning end of the EHR, it looks like just one more daunting task with not much payback, as I very rarely need information from inactive and stored charts, and, to be truthful, records older than one or two years have lost most of their shine as well. I am inputting patient information like PMH, problem lists, etc. ahead of time, and this lets me completely review the patient's medical history and summarize it. I'm about one month ahead at the moment. It is really quite surprising; when a patient comes in for their first visit on AC, I actually remember all of their issues because it is NOT buried back someplace in the chart, even electronically. It is certainly more personal work than having a high schooler scan things in mindlessly, but it sure does make that first encounter go smoothly and my patients seem sort of shocked that I am addressing all their past issues, even briefly.

I started using AC to do all my chart notes years ago and then 3 or so years ago I started scanning in all of my new papers... over the next year or so I found myself using the old paper charts less and less. Now we scan in some as time permits, but I really never look back. If I need an old x-ray report, mammogram report, colonoscopy, etc I simply use the orders or even a scrip to write what I want and fax it to medical records at my small hospital. They copy the requested information and fax it to me - import and done.

I actually found that even old patients if I review all their surgeries for instance pts will remember one they forgot, etc.....pays to not just rely on old data and refresh it.

I don't think we will ever scan all old charts and eventually years into practice will be able to just shred/throw away.

I'm all about getting rid of charts as soon as possible. They may save your bacon or they may fry it. To a lawyer with a bad attitude (redundant) skillet it all looks the same. I say get rid of them at 7 and a day. By then very little really matters or it can be found elsewhere or it doesn't really matter. They had a reaction to SOME anaesthetic. Which ovary is gone. Do they still have an appendix?

I have the obsessive gene too Jon. Heck, I am an Internist so that goes without saying. but I am paranoid too.....

Here is another reason to not blindly scan everything:

We are very selectively importing items into the chart using UpDox (that is, just faxing it to ourselves.) This would be horribly costly if we were inputting huge numbers of pages, but by being selective it also allows us to clearly label everything so it as actually useful; like "Holter monitor on 0.25 mg digoxin". I believe uncollated imported records have all the utility of stew; they may fulfill the basic requirement, but appreciating one given item is pretty hopeless.

Just starting with AC and wondering how to scan the records into AC using the ScanSnap. Can the old labs and xrays be scanned into a separate lab section? Is it better to just scan old chart as a whole? The scanner saved into pdf files. How do I transfer to AC? Also, the scanner is currently connected to a network computer. Does it have to be connected to the main database computer?

Welcome. The old labs and xrays can be scanned into separate lab sections, in fact, this is sometimes easier because you're using a scan snap. I'll let others comment on whether or not it's better to scan the chart as a whole, but from what I've seen (as a not-a-doc) what is really needed are the last encounter/physical, last years records, last lab, and of course, all vaccines. PDF files are a good format. To get them into AC see my last paragraph. Keep your ScanSnap connected to your network computer. It does not need to be connected to the database computer to add files into Amazing Charts (and therefore to the DB computer).

The following is from memory, but I only have it memorized spatially. To setup your ScanSnap double click on the blue S in your task tray (lower left in Windows). The window that pops up will have a check mark, uncheck it to manually set your ScanSnaps settings. A menu pops out below with tabs. Click the left most tab. There is a drop down, select Save-to-File. This defaults to your local My Pictures folder, change it if you'd like. On the right-most tab move the slider to the highest compression setting. This could be a problem if your computer is slow, so tell your staff to start scanning the file before they begin doing the steps to import the file. You'll only need to do the setup once, be sure to post back if SS starts flipping your documents. There's a setting for that.

Now you're set. Just press the scan button, then open a patient chart to the Imported Items tab and select Import > From File. Now select the browse button and it will open directly to your My Pictures folder (well it will next time, browse to My Pictures). Just enter the scan information now, and be sure to check the "delete after importing" box.

If you don't like the list of pre-set file types please right click on the file in Imported Items, then select Edit. This time you can enter any file type you wish, so instead of "Radiology" you can use "Xrays". If the folder already exists you can just drag the file to the folder and it will be re-classified.

HTH, but I'd appreciate it if you'd do me a favor and let me know where I havn't been clear. I would like to clean this up and put it into the wiki. Maybe with some screen shots.

(PS: You may prefer to drag and drop from your My Pictures folder directly into the Imported Items tab. It may allow you to keep from having to enter the item type twice... sleep.)

I love the ScanSnap myself! It is also nice in that it comes with the full Adobe. I would really like to be able to change those categories, like Radiology, permanently in the list. Moreso, I want to add my own categories. For instance, there is no HOSPITAL section, and one MA might put in Hospital, another HOSPITAL, another Hospital Recs, etc on different people's charts. It seems like it would be easy enough to allow people to edit the pull down list of categories

I have 2 SCANSNAP machines and use PAPERPORT too.
All the old charts are scanned are the tranferred to a shared directory on the SERVER, so that it is accessible in the office and remotely.
The problem with attaching or importing to AC is that you cannot stack your imported items.
All my labs, correspondence, consultant letters, hospital admissions and discharges summaries are stored on a shared folder on the server.That way it keeps my AC clean of clutter and no problems with delays with booting up.
I do use the TRACKING features of AC in the SUMMARY section to track all my PAP, MAMMOGRAM, HEMMOCULTS, PSA's and COLONOSCOPUES.
That is one of the cool features of AC and hopefully prevent many MEDICOLEGAL problems - " ACTS OF OMISSIONS" as the lawyers like to call it

GRENVILLE

I have a little different issue. I am about to switch from another emr to AC. Is it worthwhile to move patient data to AC or should I run 2 parallel programs into the distant future?

Several different aspects to this, but here are some points to consider:
How hard is it to get the patient data out?
How much will it cost you per year to run your old EMR as an archive?
How much data can you get out to bring over?
Of the data that you can get out, how much of it can you match up and get into AC?

Conceptually it is significantly better/easier to run one EMR, but that may not be practical for you.