Home Forums Discussions General Discussion Chart Storage

hey guys,

i understand this is off-topic, but considering how helpful everyone has been,i thought i would try this.

we have a small office and were getting more patients than we could store. basically, we had to store some of our charts. they are placed in a uhaul unit about five blocks away. the boxes are stacked up to the max, charts are hard to find and it is generally not a great place to go looking for something.

because we are mandated to keep charts for seven years, we obviously just cannot shred them all (though, considering the practice is 10 years old, we have some charts that we can get rid off), we are looking for a service to help us. is anyone aware of company that can help save the charts we cannot shred to some sort of computer file and shred the ones we can get rid of? or any suggestions on how to handle this?

any input is greatly appreciated! thank you in advance!

Scanning charts is very expensive...we just store charts offsite and when a patient has not been here or called for 7 years it is destroyed...except shot records...

i understand they are very expensive, but we never go there because it is such a pain and are viewing it that we will save in the long run from paying the storage bill?

Had a similar situation and made the change to a company that stores and retrieves charts several years ago. Big mistake. Although it looked like the costs would be similar, they started adding on all kinds of fees and extra charges. Now, after using AC for a couple years, stored items are dwindling and shelf space is being freed up but we are being charged an arm and a leg to shred and or retrieve our remaining charts from the storage company.

Patricia,
Far from being "off-topic", I think this is a significant issue. I find that for many docs who are considering an EMR, the issue of what to do with paper charts becomes a major stumbling point; in my opinion, it assumes far more importance than it should.
You are well past that stage, but the issue remains. I advocate scanning and shredding in most cases. The costs of storage are significant and sometimes hard to quantify. As you point out, once the items are stored, for all intents and purposes they are essentially inaccessible, only to be retrieved in the most extreme cases.
The cost of scanning by a company can be significant as well. A cost effective alternative we used was to hire a high school student and buy a scanner. The job is fairly mind-numbing, but to a student (or your child) who is looking for work over the summer or on weekends and after school, it would likely be popular. I would generally do a "batch" scan; don't spend a lot of time and energy dividing the charts into a lot of sections. If there are significant portions of many charts that need not be saved, show the scanning person what can be trashed, and have them scan the rest. Also have them get rid of charts on patients that have not been seen for 7 or 10 years, or whatever you feel safe with.
When the scanning is done:
no more costs, no more charts lying around, no more "do we want to send someone over and try to dig it out of storage". Instead, you have the psychological satisfaction of getting rid of all of the old charts, and you have a hard drive that sits on a desk or in a drawer so that any chart you want to browse is quickly accessible.

great answer...we are going to do this soon..

exactly...scan in, the destroy the chart. There are companies which will destroy the charts for you.

jon, (and everyone, really), thanks for the reply!

i guess because the doctors do not need to go to storage, they do not understand the task of finding a file amongst a ton of files that were often not stored in the right place and just sort of boxed up.

we have someone that is scanning our charts now. the only problem is that i feel some resistance in the docs willing to shred the charts despite the fact that we have been working with AC for nearly 5 months and have RARELY, if EVER had to gone back into a chart to retrieve the information. we don't really shred anything! it is frustrating, but i know that people work with what is comfortable to them.

the woman is almost done scanning our patient charts in and i truly believe that she could handle pulling the charts from storage and going through the boxes, inputting what we need or shredding if it past the limit.

my question is : for the charts that are not 7 years old, do we enter them back into amazing charts? even if the person is deceased?

We also have a storage shed, and now electronic for 2 years. We started scanning in all the active paper charts. Next, we will start with the most recent stored charts and work backwards, shredding them as we go, and also shredding the charts as they age beyond 7 years. We scan them into a PDF file using Adobe, and have them out on the server in a shared folder, not as part of AC at all. If I want some document from the old chart into AC, I just print it into AC using UpDox. The active charts were indexed in Adobe, but the older ones are just scanned in with no indexing. We typically just shred the files of deceased patients. I shared the reluctance to shred paper, but after I saw how much easier it was to find old information from the scanned charts, I changed my mind. With adequate backups, electronic is about as secure as paper, and it sure beats going out to an unheated storage shed in the middle of winter.

That dynamic applies to many different situations. Of course it never happens in my practice! Sometime when a doc asks for an old chart, one that has already been scanned, tell them that your staff is really busy, but would the doc mind going to retrieve the paper chart themselves...just this once. The answer at that point will likely be "well, I guess I don't really HAVE to have it". At that point you whip out the scanned version and remind them how fortunate they are to have such a well-prepared office manager. And remind them how great it will be when all of the charts are scanned and so readily accessible.

Although this makes little objective sense, it is also pretty common. We still sometimes have a hard time trusting that the computer won't lose a chart. All you can do is keep asking, "when was the last time you LOST a chart that was already in AC? And, once all of the charts have been scanned: "wouldn't it be great to stop paying that money in rental for the storage...because no one has set foot in there since we finished the scanning".
The storage of pdf's outside of AC that David proposes is a good alternative; there is really no need to put the scanned old charts into AC. We did put them in, but I can see a case for both views. On the other hand, I would suggest that you and David keep the following in mind. Remember the tagline of the movie "The Sixth Sense" which was "I see dead people"? As physicians, we generally do not see dead people. Lawyers, on the other hand, make a lot of money from dead people. I hope this never happens to you or to us, but we have to be prepared.... if you get a request from a lawyer for a chart on a dead person, then you need to be able to find that chart. The easiest way is to have a deactivated patient in AC, or you can have it stored externally, as David suggests. But do keep it, even if the patient is deceased.

This can be a dilemma, and I agree with what everyone is saying, but I don't think it needs to be this difficult. There are many options which work:

1. Scan all records into AC and shred the paper charts. My favorite. Why have two copies?

2. Scan records into AC and keep an electronic record. Solves both issues. You could burn the PDF onto a CD, name it and give it a date using LightScribe so it is professional. This gives you an archive AND allows you to simply copy the CD when you need to give a record to someone. If they haven't been seen in AC since the date you have it all. You can archive the records in many places. One good place would be a Networked Attach Storage with a RAID5 that is copied over to a second one. That should cover you. And, you could grab a file from any computer. They can also be encrypted.

3. Don't scan into AC but do the other above. Personally, I would go with the NAS. Don't put them on a USB hard drive or thumb drive. Put them on a heavy duty NAS. Get a company to do it for you.

4. My absolute favorite. Scan the records either in any way above. You are all set. Then have a big party with all the docs. Make sure it is open bar. After two or three hours, sit them all down and just tell them, "No more storage. Who wants to keep the records at their house?" Maybe give him/her half the storage money each month. Just tell them either they take the records and are responsible for bringing the record in the next day or you are torching them.

A lot of doctors are resistant to change. But, I have to be blunt. They need to get over it. What is the worse thing that can happen? They lose a chart. If they lose what is current, it is pretty bad as well.

Jon and Bert... Your answers are priceless. Jon, I checked with my office manager, and all deceased charts have been scanned in. I was talking through my ...er... hat when I said we just destroyed them. I can see myself in your pictures all too clearly. Patricia, have patience. Believe it or not, doctors are educable.

This is our results from scanning all paper charts over an 8 month period:



The company that we paid to shred the file boxes full of paper charts said they were doing record business with local docs.

^ Beautiful ha. We did the same. Hired a high school kid to scan all the charts.

I was very nervous about destroying paper charts as well at first. So, we boxed them up and put them down in the nice crawl space under my office. Some were charts of patients we had not seen for 5-6 years and which were not scanned at all. Unfortunately (actually fortunately) the sump pump failed and the space flooded, ruining most of the charts there. At first I was very nervous but as time went on I realized I never had requests for those charts. I had been very proactive over the last 25 years in practice and culled charts over 7 years every January. These were shredded so the number of old, old charts in my possession was already low. We still have some paper charts of very elderly patients that we did not totally scan into AC but I cannot remember the last time I had to pull one.

Can't remember the last time you had to pull one or just can't remember?

Remember what?

you guys are hilarious! i invite everyone to the clinic for a shredding party. as long as you take the blame, i will provide the booze and get-a-way cars!