Home Forums Discussions General Discussion Seeking input on scanning paper charts into AC and beyond...

Howdy,

My solo practice is about to enter the abyss and we are seeking input on scanning paper charts into AC (we have an in house server and high speed scanner) and then how to truly go paperless in the most efficient manner (we need advice on how to create interfaces, etc. and are curious what has worked best for those who have already made the journey.)

After reading the forum topics, it appears there is less trouble opening imported items if they are saved in pdf format- True or False? Other options? The issue here has to do with staying efficient by not having to open/close AC while accessing imported data.

After we have a chart scanned, demographics and insurance info setup...how can we minimize the amount of scanning we will have to do with items that will be received into the practice from outside entities-labs, home health, nursing homes, pharmacies, etc... We know that setting up interfaces with the labs is a key first step. What other suggestions regarding this complex process would you recommend?

All input is greatly appreciated!

DRM

PDF is the way to go, they can be of different sizes depending on the compression and what level they are scanned. I found 200-300 dpi scanning worked best with moderate to large compression if available
It helps to have a 2 sided scanner, although many charts are one sided.
There are a couple other ways. All faxes should come in as PDF. This can be accomplished with Updox or a scanner that imports to PDF (Most Brothers, some HP) Most of the input you described comes as faxes. When paper comes, just scan it and move on. Fujitsu makes a popular small fast scanner that sits at the front desk of my offices. It used to come with Adobe software, but I'm not sure it still does.

DRM,

I elected to keep the paper charts in my office and scan items as needed, such as labs and colonoscopy reports. I did not scan entire charts into AC, but would dictate using dragon family, social history, type in allergies and meds, copy and paste past med history information, and enter diagnosis codes a week before the visit. This would take usually 10-15 minutes per chart, and clean things up a bit, so the data entry was a bit more streamlined at the time of the first visit using AC.

I initially used the Fujitsu scan snap scanner quite a bit but once I implemented Updox for e-faxing in and out and getting my new 800 fax# out to all labs, docs, pharmacies and hospital, the scanning slowed down quickly.

If I had to do it all over again, I would replicate this method in a heartbeat. I have no regrets not scanning in entire charts, and about two and a half years from converting from paper to electronic record, the paper charts sit idle, and are rarely ever touched and useless at this point.

We elected to scan the bulk of old charts into a separate file not part of AC. Big imported items files get very slow. I recommended importing into AC selectively.

I forgot to mention, that David gave me the idea to get the chart ready a week before, and in my opinion saved my staff an incredible amount of work, doing it this way. It was a bit hard on me, but I got through it.

Initially, we imported all, but then started doing selective importing of active patients. We have a shared folder with functionally or really inactive patients that we can search if we need.

Initially we separated the scans into separate sections, but that devolved into 1 complete scan, following the normal separations of a paper chart. If you need labs or copy's of physicals, they would be in the back end of the scan.

We went at this a little backward. In 2005 we decided to go to an EMR, but couldn't decide which one. We understood that old charts don't belong IN the EMR, as "paper under glass" as they just take up space and contribute little to the function of the EMR.

Accordingly we set up a server and high volume, double sided scanner (expensive) in 2005 to scan OLD charts that were scheduled to go to storage. Thus we stopped storing old charts. When we had thinned out the racks of charts in the office we began hauling the old charts from the storage unit back to the office and scanning those that needed storage and boxing up the older than 10 years / inactive charts without scanning. All of that then was shipped to a commercial shedder. All the scanning was done by staff in the 'off' time, when we were not seeing patients. No overtime. (You have NO idea how much of that you have, Dr. at hospital meeting, making rounds, etc.)

In 2007 we went live with Amazing Charts. As per the general wisdom we marked a few pages to be scanned from the current chart and then entered a good bit under PMHx the night before the visit. Lots of work. We kept the old chart and used it with the EMR for the first two or three visits. When we felt we had all we needed (maybe after one visit, maybe not for 6) we sent the remains of the paper chart to be scanned and shredded. After 18 months all the paper charts, new, old, in storage or in the office, were all gone. Tore out the metal racks and moved some desks in the space!

I am not sure the big, double sided high speed scanner was worth purchasing. We ultimately needed multiple sides with small scanners and we could have bought them with what we paid for the big scanner. And the big scanner could scan pristine pages fast as heck, but old dog eared charts? not so much. And staples or paper clips? REALLY BAD for the big scanner, which went down several times, then we threw it away. Multiple people on multiple small scanners, (we like the Canon DR 2010-C best) might be the best plan.

Most old charts are scanned using the old systems ID numbers, (we started 2 years before Amazing Charts) and now we sometimes have old records that get scanned but have no old number, and little need to be in Amazing Charts, so those get scanned with the number "ACxxxxx". (records from an acquired practice for example) In the demographics, under "other" we record where the old records are, and they can be opened with a program called capture perfect that comes free with the Canon scanners.

That aspect of the whole thing works well.

Thank you all for sharing your experiences and helpful recommendations! PDF and Updox sounds like the way to go. Getting the data entry a week beforehand makes a lot of sense.

Is it possible to purchase an older non-medical version of Dragon as opposed to the more expensive medical version that is compatible with AC? Dictating in the past medical hx, Family hx, meds, etc. sounds very efficient.

Thank you again for all the useful comments,

DRM

You have to go back to something like Dragon 9 to avoid the EMR blockade. Dragon 9 is fairly good, but to be honest I'm not sure it's a lot better than Windows Speech recognition that's build into Win 7 and 8. That's what I use, but I don't dictate much.

One thing to keep in mind with Dragon medical is that you can install it on multiple computers (not sure how many) which you are not supposed to be able to do with Consumer Dragon (I think you can actually put it on a couple computers tho)

My previous comment was sent fro an iPad, so let me elaborate.

Most of an old chart, if viewed critically, is pretty useless. Once we cut over to AC, we kept the paper charts around for most of a year, importing only those things that were clearly going to be useful. Those we imported via UpDox. After a year, the value of the old chart starts to decline dramatically (especially if you did as Jimmie mentioned and enter a compacted "classic Comics" version prior to the first visit of a patient in to AC.) After that, it no longer takes a lot of medical thinking. We hired a high schooler equivalent, and started scanning backwards; most recent visits first into a separate folder outside of AC. By then, it pretty much became a matter of putting not very useful data someplace for medical legal purposes. By now, I need to look at an old chart about once a month at the outside, and paper is pretty much all gone. I will say that I think it is important to not put more than you really need into the imported items part of AC. It can really slow down access to data that you really do want, and is not necessarily the easiest place to find what you need.

We scanned charts into PDF format and then these scans were saved on a separate hard drive. A link was placed on each computer so that we can review old records as necessary. If something needs to be imported into Amazing Charts, we print it to UPDOX and import that way.

I didn't want to import everything into AC as having a very large imported items folder can slow down AC. Besides, there's a lot of old information that we really don't need in AC (old pap smears etc).

We used the exact process as Marty. 1st patient visit after incorporating AC we updated the PMx, Social, ect, scanned (before the visit) pertinent recent labs, x-rays, EKG, into AC. Old charts are scanned as PDF into a separate external hard drive then shredded. We have a link to access the old charts and review or import anything extra we may need, such a prior stress test, colonoscopy report, hospital report, etc.

Please make multiple backups at multiple including offsite areas as you will need to hold the scanned chart for greater than 5-7 years
Hard drives die, can get viruses etc
32 gb USB sticks are cheap and also will need to encrypt data so that no one can walk out with your entire practice on an external drive

We made the decision to scan all of our old records. As I have posted before, that partly reflects the OCD side of my personality, as well as the nature of my practice. As a gastroenterologist, a significant number of the charts were not large, but it was important to have quick access to a colonoscopy or other report that might be 5 or 10 years old. We scanned all of the charts, generally "thinning" useless material and either importing the rest as a single batch, or in a couple of categories.
It felt really good to: a. shred and dispose of all the old charts, and b. know that I had quick access to all of the old information.

Yes, create pdf's, and yes, use Updox.

Having said that, I think that many people who are new to an EMR worry too much about how to complete these steps. There are several approaches described here and elsewhere. Pick the one that sounds right to you, and go with it. In my experience, it is unusual to hear people say, in retrospect, that they wish they handled their old paper charts differently. The decision probably doesn't really matter as much as it seems to matter to you right now.

One other point: Marty and David bring up the issue of large imported items files slowing AC. I think that this is a real issue, and I have worried about it. On the other hand, I believe that it is not a common problem, and while the size of the imported items file is one of the factors involved, it is not the only one. I think it is prudent to use a fairly small resolution for scanning (e.g. 200x200) but I do not think it should deter you from scanning old charts into AC. Just my opinion.

I totally agree with Jon

Great input from everyone...just wanted to say thank you for the support!

DRM

I also ran into this issue because I absorbed another MD's practice. (I was using an EMR since residency.)I have found the old paper charts to be minimally useful at best. For the most part, you are saving old charts for medico-legal reasons. We did scan a lot of the recent charts, but I too recommend being very selective about this. Most of the old charts are now in boxes, sorted by alphabet so we can occasionally (once per month) find an old chart for a lawyer or insurance company. Generally, patients do not care about their old charts. Now many of them are coming up on 7 years old, and they can be shredded in our state. (Or 21 years old). There really isn't much reason to scan the old charts into a file - you just have to store the paper for at most 7 years (in our state)and then shred/burn. YMMV: I think California is 25 years!