Home Forums Discussions General Discussion Closing a Practice - Records Retention Question

After 8 years in private practice (5 using AC) I am thinking of closing my practice and joining a local health care organization as an employed provider. The downside is loss of autonomy and the use of EPIC, but the upsides are numerous (better pay, IT support, no administrative duties, etc.).

Since I would not technically be selling my practice, just shutting it down, I'm wondering how best to keep records that are stored in AC. I really don't want to have to maintain a computer with AC on it, just to access records for the next 10 years. Does anyone know of an automated process to print all patient records as a batch? I'd prefer to save complete records with all imported documents as a pdf file for each patient. That way I can store the records on DVDs and access as needed.

Anyone have an idea how I can do this? Anyone have a better idea?

It would be very easy to set up an Amazon AWS micro cloud server instance and upload your entire AC practice there. The machine won't be very active and unless you're storing imaging you probably don't have a huge data set. You could also do the same on Microsoft Azure. Should only be a few dollars a month to have the practice data available in its current form.

Alternately, you could have someone export the SQL data into something usable to humans and put it on a flash drive and lock it in your desk drawer (HIPAA data at rest, right?)

Sorry, I am a newbie a this. How would you put it on a flash drive. Don't you need the AC program to run to access the sql database and the imported items? Isn't there a way just to archive everything under patient names for easy access either from cloud or flash drive?

Another option is to set up a machine at home and remote into it if you need it.

You can use NOip.com to point to the home machine without a static IP and use windows RDP
or get RemotePC (one license FREE but even 10 are $6.95 PER YEAR, going to $49 after that. (or 100 for $49, then $499 after that)) Waaaaay less expensive than LogMeIn or Teamviewer (technically not free for commercial)

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I don't believe he is talking about running it from a flash drive. When you make records to send to someone, you either have to combine them and print them, burn them to a CD or put them on a flash drive. The only thing you would be doing is putting "the records" on a flash drive. Companies even make flash drives specifically for this with the name of your practice on it. The advantage over printing is obvious, over CDs is you don't have to take the time to burn them (although you have more room to write or burn name on it).

Neurodawg,

First, congrats on your new move. I don't think Epic is a bad as Centricity, lol. All of the above methods are good. I have three ideas, that I feel are the only way to do it. I wish I knew how long you had although it doesn't really matter. In some sense you have 30 days.

First make several backups of your database. Hard drives go bad, etc. I mean the hard drives you go back to. Maybe even put one in a safety deposit box. We are talking ten years here. When you are absolutely not going to use it again, MAKE A BACKUP USING SSMS ON SQL ITSELF. This is the best backup you can have.

Second:

a) one way is to "hire" your own service. Say someone like a 16 yo (if you can find a way to designate him as a HIPAA compliant employee) and pay him for each CD and stamp. etc. You don't need DVDs, only CDs.

b) I looked but couldn't find but there may be companies out there that do this. I would thing the graph would look like a backslash from the top of the x to the bottom of the y, with ten requests one day to one request on each day once you get four months out.

c) If you haven't signed yet, make this part of the contract. That a receptionist at your new job is responsible for doing these and use flash drives. Much quicker. The only issue with flash drives is it took two years for other practices to figure out what a CD was. They were like, "Where's the paper?" Some companies don't allow flash drives and may not even have USB ports on their computers. Flash drives are way more likely to contain viruses.

c) Best method: In my opinion the best method if you have two to four months to get ready is to hire someone or use one of your staff to go from A to Z, makes pdfs, and burn them to CDs clearly labeled with not only names and DOBs, but a large number associated with an Excel spreadsheet. Make 26 boxes to put them in hopefully in alphabetical order. I remember when people changed to AC, one user who is still on AC had his staff move EVERY paper chart to AC at one time, not as they used them like most practices. I thought he was crazy. Once this is done, and it will take 40 or more hours, it is done. When people ask for records, you can mail them or, better, have them pick them up. You can easily make it sound like a favor. "Yes, Ms. Smith, I already have that ready for you. Can you swing by and pick them up? You can also have the technology 'two CD burners in a computer' or a more high-tech machine that will copy CD to CD or, easier, CD to flash drive. This means you can tell her that if she swings by you can give her two copies, one for the practice and one for her. People would salivate at the idea of having their own record. A flash drive from a company that you buy in bulk (I say flash drive, because it takes seconds" would allow you to get a signature from the Ms. Smith so that you don't get a SECOND NOTICE, THIRD NOTICE from the practice that swears they never got them.

In my opinion, there is no other way than to do it all at once. Yes 15% of them will sit in storage or your office or at home and never get picked up, but it would be great to have them done. When you make them, save the PDF on a computer, so that when an office states they didn't get it, you can send again quickly.

Another idea is to throw a CD or flash drive in a box clearly labeled for an office marked January, February, etc., and throw them in the box. At the end of the month (even though one was put in two days ago) take the box to the office and dump them. Have them sign off on them. Or mail a package.

Keep in mind, records mailed directly to a patient or picked up by a patient DOES NOT need a release. We obtain a records release if they pick up just to have a record, but it is not necessary otherwise. If you wish you can encrypt or password protect the pdf if you send directly to the patient.

Lastly, when someone asks for records, make it very clear that it will be there within 30 days. You do not have to go in separately and send some records because they have an upcoming appointment. This is definitely true in situations where a patient voluntarily leaves an ongoing practice. In this situation, they have no choice so, in good faith, you probably could.

I also can't talk for every state, but in most it is a myth that you give 30 days. A healthy person may only have 15 days to find a new doctor and a sick kid may need 60. But, this doesn't apply to you.

So, in review, doing them all at once or having them done at the office (both could be done at your new office). Just keep track of Smith so you don't have to do her again.

Thanks Bert for the info. Lets say doctor is going to change emr as above. Now he has to have a running AC to access old records to put on either CD, flash drive, or fax to new doctor. You say to backup the database. Is there a way to put the whole database of patients either on hard drive or cloud where you can have easy access once you stop using AC? YOu just click on database, find patient info, and do what you need to do with the info without having to actual having a running AC program . Right now, I thought only way to access those patients was by running AC and click on patient.

There are a few services for this:
Desert River: http://desertriversolutions.com/custodian-of-medical-records/
Clary Document management: http://www.medicalrecordcustodian.com/
MyRetiredDoctor: http://www.myretireddoctor.com/

Hi tvo7,

First, John, thanks for those. I think the above services would be extremely helpful. Of course, I doubt they will keep on AC. They would only have on a pdf or something or paper records and give out. But, a good way to be out of the middle.

So, I would likely stay away from faxing. To fax without wasting tons of paper, you would have to use a fax server. They may be fast, but they may not, and they may not be as accurate. Plus, you are at the mercy of the receiving office getting it or saying they received it.

To answer your main question, it would be very difficult if not impossible to just have a SQL backup and go from there. You could if you had AC, but then you would restore all to AC. While a good SQL expert could probably back up a copy of just the one doctor, it sounds more complicated than it needs to be.

Even if the departing doctor purchased a license for just one year, you still have the issue of HIPAA. I suppose you could get around that as he could still come off as medical colleague of yours.

This is why, in my opinion, the best way is to have a date when he finishes, keep track of those who have already requested records, then come in with some help and just crank them out. We are able, via pdf and our system, make a pdf of the records on any patient in about three to four minutes. This would be the pdf you would want on the external drive you keep. This would be the drive you would want a few backups of. Or to send to one of John's services above. I think medicolegally, you would have to keep his patient charts still on your database as they were once patients there.

what do you think of this idea bert. Lets say doctor retires and his ac is version 11.
He has a copy of version 11 installer on google drive as a backup and has a SQL backup in a secure cloud website like carbonite. Meantime, he has a running copy of version 11 and sql database on computer at home for any records request. If computer crashes then he can just run the installer, and restore database onto new computer. He does this until the end of his life. Does this sound like a reasonable plan for a retiring doctor?

Sounds good, but maybe a few small glitches. I think most of the commercial cloud websites are SQL compliant now, but you need to make sure it can back up SQL. Of course, if you do the SQL backup locally and then move it to the cloud, you are probably OK. You should also look at Amazon Web Services or Azure. Something very vanilla but will be there a while. You mostly pay for the data size. I am not sure if you really need those things in the cloud. A backup on the computer plus backups to three external drives in various places. A very expensive fireproof and waterproof safe would help. Safety deposit box. A friend's house after it is encrypted.

As for version 11 on your computer. You would need to check with AC. First, since it has never had a version installed, you would need AC to install it with activation code and your backup. I don't know, but maybe it needs to be installed at your office if part of their activation has to do with your IP. I don't know. I also don't know if it has to be connected to the Internet to "phone home" when obtaining files. Probably not. If it crashes, you would need AC to install it. Maybe have to pay for an entire license. May be better to have a inexpensive server with Hyper-V and some VMs with some on another computer. You would have to talk to Sandeep about that. The key thing is that if you are going to have a computer at home, you need to know:

1. Can you install to a new computer if you don't have support contract?
2. What would happen if you needed to install again?
3. May be better off with two PCs, so you can install to one, then install to the second one, so it is already installed.
4. Need to know what happens when your license runs out. Can you just pull the plug on the Internet and make records without a connection?
5. You will likely run into some issues if five years down the road you need to install to a new computer. I think if your computer it is on is fairly new, and you aren't going to be using it, it should run for quite a while.
6. You can make tons of AC.enc backups to a couple of drives, given you aren't adding anything.
7. You could also ask how much it is to use the offsite backup per year. May be worth doing that.
8. I don't think you need to do this until the end of your life. With adult patients, I believe it is six years. With pediatric, it is up until 18 or 21 plus six years.

I have recently started using an encrypted email service that is claimed to be hippa compliant. the name of the service is virtru.
it is easy to use.
one drawback is that many doctor offices are not yet ready to receive the records as an email
Anybody using this or another hippa secure email service to send med records

Our local FQHC uses something like that.
It is a real hassle at our end.
I mostly ignore the records.
EMR has taught me the wisdom of Henry Ford's dictum: "History is mostly bunk."

That is because it is an FQHC. Not sure about everywhere, but the one here is pathetic. It is only there so the CEO can buy as many practices and build an empire. He is losing because the local hospital system is out buying them.

I imagine anything that an FQHC came up with (read government came up with) would be horrible. Going back 12 years, a product called Certified Mail had a beautifully constructed HIPAA compliant program. It is the type that most hospitals use where your email goes to a secure server, and the recipient only gets a message that the email is there. With CM, if you were a new recipient, the message came with your email address ALREADY IN THE USERNAME FILED FOR YOU. Below that was a create password field and a confirm password field. Hit enter and it brings you back to the same screen with the email already entered. You type in your password, and it takes you to a screen with all of the emails that you have on the server, much like looking at a Yahoo or Gmail site only much cleaner. You can reply for free. You could download the attachment right there.

Currently, so we don't have to print out 300 pp, we combine to a pdf (as I am sure many people do). We then have to either fax it using Windows Fax and Scan which isn't 100% reliable, i.e. you may have to send again or burn to a disc and mail. So, total cost is for the CD, the envelope packet and the stamps and the time of the person putting it all together. That is still going to be around $2.50.

To be able to make the pdf and simply email it, is much more efficient. You would obviously keep the pdf somewhere on your server, but you would also have a copy in the cloud with a receipt and, thus, proof that the other office received the record. So, you can combat their 2nd Request and 3rd Request, etc.

I think a lot of us ignore the records until we need them some time. And, when the next office wants records, it's nice to send the entire record.

Any way to roll back to an old version of AC, where you could keep it and run it for free albeit without access to electronic prescribing or support? Or did I misunderstand those rules?

With above, would go the home server route that Wendell365 suggested.

PPS: From this thread:
http://amazingcharts.com/ub/ubbthreads.php/topics/71773/Harris#Post71773

in reply by Indy,

"We have done multiple data conversions, so I can tell you data could be reverted to 6.3.3. Depending on several different factors, it would be an alternative."
FYI

And, why can't you just bring the computer home and leave it at v9?

Sorry for late response, things are getting hectic here (another solo bailing, can't afford to retire yet, nor really want to, but can't keep up all the spinning plates of running my own office - as an alternative, get to learn Epic, oh goody!).

I was debating that question, Bert, and may just do that. However, with the rollover from one owner to another to another, I was worried about losing the ability to move AC to a new computer at my convenience, especially without incurring significant additional costs.

As I understood (or perhaps misunderstood), for older versions (when Jon still owned company) one could opt out of support, electronic prescribing, etc and maintain a low-cost/no cost setup. With the older versions (not sure which was the last that worked that way), one could also move everything to a new computer whenever needed, without having to jump through current hoops, and even have it set up on more than one computer at a time (a nightmare if still adding info, but perhaps convenient for just accessing information). One hassle with a rollback like that is perhaps losing some of the (few) useful meaningful use info/summaries (easy-to-find summaries of last screenings such as last mammo, DEXA, immunizations, etc).

Any thoughts greatly appreciated. And, Bert, a special thank you for all your useful and interesting input on this forum.