Home Forums Discussions General Discussion Old Records

Just asking for some suggestions on old records. I have a relatively new practice ( almost a year old) with about 1500 patients. Should I scan in all of the old records into an "old records" import file or should I just keep the charts I have and start with new info? Should I only scan in labs and studies? Just some questions before we dive in. I have a pretty good Fujitsu scanner already which will be up for either task. The less work the better, but if i can eliminate charts all together that's good too.

Thanks,
Ron

If I understand correctly you have no records older than approx. one year? I would scan the whole thing into AC and shred the paper. I would take the time to pull Labs, Consults, EKGs, and X-rays, scan them separately and get the date right on the import action. Then the progress notes, and any miscellaneous insurance info, authorizations or whatever goes in one spot, "old Records" but be sure to label it with your name so you can easily spot your old chart from records received from another Dr.

I scanned about 5 years of charts. Initially I tried separating them, but because there was usually one a lab or two (in Peds we don't have a lot of labs usually) it's almost easier to scan the whole chart and add to the import items. I picked up a corporate fujitsu scanner that does about 20 pages a minute on Ebay and it worked well.

Doc:

You can scan to a new database in pdf format in alphabetical order, not necessarily into AC, though you could do that.

Re: the original copy: you may need to check with your State, as to how long you need to keep them- likely for 7 yrs.

Now you could shredd after that, that will take a lot of your staffs time. It really does. Or you could give it outside company to shredd, that will cost a lot of money too.
Consider in winter, if you are in nothern states- an outside wood burner- people use to heat the house. It will heat the house and you got rid of your chart securely.

I get -100 points for not being 100% green here. But you save your staffs time- that gives me about 50 points, it heated the house and that gave me 49 points. You could choose to pay for whoever does this - nominally, they will be happy- that gives me about 25 points. Net is +24 points.

Good luck.

Joe,
We put our personal junk mail and other stuff in the fireplace and it simply becomes part of the kindling to start the next fire... But be careful if you stack it to tight or high, you can actually have some unburned stuff in the middle of a pack if you just do a short little burn simply to burn the paper...

At the office we shred as we go. We are on our second "micro-shredder". And to contain and get rid of all the tailings, we are buying big paper lawn-leaf bags. Those can go in the paper recycling dumpster as is and we aren't having to take out that part of the garbage twice or more a day. That was Nancy's idea. I dare anyone to put these tiny little pieces back together....
Paul

Paul

the stove I am talking about is: a big one. A real big one. Nothing survives in this one. (just dont tell me I get -150 points now)

We have not gone completely paperless, and some of the charts for > 3 yrs that we have scanned do return, so we have held onto them. I do have a fireplace though...

I've been in practice 5 years, 3 years solo and we are 5th month into AC. We have 2,000 pts and have been scanning all of our paper charts. I want absolutely no paper charts to lug around. We have only about 10-15% of our charts remaining to be scanned.

Our old records (i.e. charts from outside doctor's offices) are almost never referenced. Therefore these are last priority. We have a lot of these and will eventually scan these in too. But these won't be done until later this year.

However, we've done similar to what other users discussed above. We pulled the charts apart and scanned everything into the Imported Items tab under the "Batch Import" folder. Each .PDF file is labeled as appropriate, i.e. labs are called "labs," imaging studies are called, "radiology," etc.

Adam,
FAP??? WIth my networking, Anti-virus problems I have yet to be able to really take it for a good test drive and let Nancy have at it. But you mean to tell me, with Bert right around the corner and all, you haven't implemented using FAP as the means of scanning and filing your paper monster?

It looks so elgenent and simply I just can't wait to be done with getting the last little bugs out....

I've played with File Assistant Pro. Bert and his computer programmer have done a good job with it, I've played w/ it and experimented.

For me it's a matter of principle. To me, the point of having an EMR is to use it just like a paper chart---> everything is stored in it. So that's the main reason I don't use FAP, but rather use AC's Imported Items tab. I have a separate PM system. I don't want 3 separate systems to manage my practice. Using 2 is bad enough. I'd like to have just one system for everything but the PM system in AC is weak and therefore unusable for my practice.

I use a system which is basic yet effective that allows me to screen faxes. Our faxes come into the server as PDF files and scanned documents go into the same folder as the faxes. I review these and place in another folder called "OK to File" or "Lab Review" or "Staff Action."

My "Ok to File" folder means what it is....staff can file these in AC.

My "Lab Review" folder is mine and no one is allowed to remove or add anything to this. Labs will sit here for my use, either to review then act upon or to review and file.

My "Staff Action" folder is where I put records releases from insurance companies or prior authorizations or imaging study authorizations.

Save the paper charts, and save the scanning expense. There's little if any benefit to the rather substantial expense in time and office staff salaries.

V.

True, but there are some things to consider:

Consider the benefits vs cost ratio of taking perfectly good paper records, which you will refer to less and less frequently as you see patients longer and longer on your EMR, and converting them to electronic images. There is a VERY REAL COST to converting these, and filing them so you can find them on the computer. If you only look at the older records rarely, most likely converting isn't worth it. Seriously. It's not.

I agree it would be nice to have it all in one place.. but in an environment of $30 office visits, spending hundreds or thousands to scan and file rarely used documents is money directly out of your pocket.

For 20 years I counseled my clients NOT to convert old data. Most of them thought that they needed every transaction, every sale, every check going back to the dawn of time in their new system.. what they found was that they rarely used any data older than one full fiscal year old, which meant rarely did they have more than two full years of data online. For anything older, was cheaper to pull the file and look it up - something they did maybe 3-4x / year. We brought over all open items for all current customers and vendors. We did NOT insist that this all be there by the "go live" date. Indeed, customers who haven't bought in over a year did not get brought over.. as we might never hear from them again.

So how does this accounting software wisdom apply to medical records?

The average patient stays with a medical practice for about 2 years. People move, insurance changes, etc. Scanning records of patients you are never going to see again is an expense with no benefit. If you ARE going convert, add a patient to the scan queue if you MUST have it all in your EMR only when you schedule them for the first time after your go-live date. Don't spend your money creating electronic images of dead records. (of course, if you've won the lottery and INSIST on doing this, I'm expensive, but available :-D )

You will find that if you keep paper charts from before your EMR days, and are all electronic after your go-live date, that in about 6 to 12 months you'll only need the paper chart about 1/2 to 1/3 the time, and in about a year the number of paper charts you'll pull to review will be only a handful a day, and will decrease rapidly.

Of course, you are going to want to scan for any CURRENT patient any HISTORICAL data you use for active E&M - if they have hyperlipidemia, by all means scan a couple years worth of labs.. AFTER a real visit, where you can decide what part of the chart you want in your EMR.

Just my $0.02

V.

There is a wisdom in his advice in terms of who returns and who doesn't. We did the same thing we all our patients going into AC. They and frequently the entire family if we had multiple members under the same roof, got entered if and when they scheduled for an appointment the first time post go live with AC date two years ago. This was much easier than holding off until we have everyone in there. First phonecall or appointment, in they went. This saved us from entering those folks who didn't return or were infrequent fliers. About 3/4's of a year in we knew it was time for a visit on that first refill call or what have you, I need more anti-hystamines, well you're not in our new database and we have be using it for about 9 months now, so I'm sure that Nancy is going to want to see you before any sort of a renewal...

And we entered families in a batch most of the time simply because you've got most of the demographics for all of them right there, same phone #'s, address, carrier, subscriber, and so on. It was much easier to just do all half dozen right there on the spot as you started to remember most of it half way thru... That's why I suggested a family radio button to add family members. To create a new patient that shares almost all those same basic data points except the name and date of birth. And we can always tweak anything else if it was really needed. But it sure would be a labor saver...

We do pull the paper less and less, but that is why I want something like FAP for the from this day on paper and faxes in pdf like form that has a good naming system as opposed to the less than perfect AC system of 00000001, 00000002 and so on and so forth. This way we always know who's labs were who's even if we are forced by the gov't to switch EMR's against our will one day.... Zig Heil! I can't wait to be done with my network tweaks, repairs and upgrades from last week and finally really start playing with FAP. I think it is going to be "just what the doctor ordered".....

Vinny,

Your points are well taken and appreciated.

One other point that I didn't go into on this thread (although I've mentioned it in other ones), is that I'm moving into a new office down the street from where I'm at now. I'm currently renting a building but will move into a building I've purchased. In my new location, I literally do not have the space for my paper charts.

So for me, it's a mandatory requirement to get rid of the paper.

I hear you on the cost thing, however I have not been paying any outside source to do this. I'm using my staff. They have to be there regardless of how I utilize them. They could clean the floors or scan charts. Since I'm not paying overtime, I am not really spending extra dollars.

I had to buy a Fujitsu Scan Snap, but I'm glad I did because we need that for scanning out mailed documents. I see that as a fixed expense, plus it's so quick and easy to scan it makes the staff time very well utilized.

Final thing to consider, we are almost done. 10-15% of charts remain to be scanned, so it's sort of a moot point.

I'm in a fairly unique situation from a doctor-patient relationship perspective. I still admit patients to the hospital and I don't accept new patients. I've been closed to new patients for over 2 years. My patients are loyal and I have very little turn-over. I lose more patients to people moving away out of the State of Maine or to natural causes of death, than I lose to insurance issues or people getting p/o'd w/ me and leaving.

I appreciate your opinion Vinny. I think you are correct for most AC users and if my situation was different I think your advice would apply to me. Your feedback is welcomed. Thank you.

Vinny,

I agree completely with you. Currently, I am still printing out encounters and using paper charts, mainly because I have not yet determined in my mind just how I want to handle the 5000 or so charts I have. I am very aggressive at thinning out "old records" and no chart survives beyond the 7 year "must retain" laws of my state. The charts of patients who have not been here in 5 years or more (once we have called or mailed reminders several times without a response) are actually removed from the active chart rack and stored en bulk in another room, just to give my active charts the needed space. I am also fortunate that the husband of one of my employees actually owns a company that makes big industrial grinders...so we load up her pick up with papers and they are hauled off to the grinders (we do get a receipt for those records saying they were handled appropriately and they have signed all the necessary HIPPA compliance documents).
One of the reasons I have been so reluctant to convert to total electronic records is that when my local hospital went with McKesson for their EMR I absolutely hated it. It slowed me down tremendously as I could flip through a paper chart and pick out what I needed much more quickly than I can click from screen to screen. That remains an issue for me even today and I do not think it is unique to any one program. I like being able to see things side-by-side and no EMR program I looked at truely gives me that ability. On the other hand, like Adam, the physical storage space needed and the complexities of moving 5000 paper charts was a real bugaboo when I moved my office last September. In fact, my staff told me in no uncertain terms..."YOU SHALL NOT MOVE AGAIN!!" ( this was only my 2nd move in 20 years, give me a break!)
Certainly if I were just starting out I would attempt to be completely paperless. But with less than 10 years (I hope) to go, I am not sure it would be fiscally and functionally the best move. I am adding more and more small electronic features to my office all the time. I am just not sure I am ready to make the big leap.

Leslie

But, Adam, you bought a ScanSnap. Great product, but you already had a scanner in your Muratec. So, why get another separate product? Because it's better and more efficient. LOL

I guess because I created FAP with my programmer, and have used it for almost a year now, I just can't see spending all that time importing into AC and then spending all that time looking for data. I have used Imported Items at my other office, and there is simply no comparison for ease of dealing with the day's records and especially retrieval of data.

For those who scan, please, please, please backup multiple times and multiple days. And, don't just back up one copy to a thumb drive daily.

Bert, the Scan Snap is only $400.
It scans in duplex and is WAY faster than the Muratec for batch jobs. However for quick scan single documents, the Muratec is much easier and simpler. Plus it's linked to the folders where these documents go and requires fewer steps.

What are you saying? I can't backup to a thumb drive?
That's what I was planning on discussing at the ACUC, simple presentation and demonstration of how to back up to thumb drives. Dang-it, you ruined my presentation. <<Joking>>

Adam, as one of the smartest people I know, you missed my point completely. Actually, you made my point. You are more efficient with TWO machines rather than one, BECAUSE the second machine is faster and more efficient. Same as with FAP.

By the way, the Toshiba 283 that I'm getting is going to blow away the Muratec.

Geeze, Bert. At over $7000 to buy, hope you are leasing this machine.

Leslie
Queen of Frugality

1- I believe it is Federal (Medicare) not state that says you now store the paper for 10 years not 7. For sure in California it is 10 years as of Jan. 2007. I am not sure where the law came from. (but hospitals got exempted from it, grrrrr.)
2- You will pay cash money every month, by the square foot to store the charts as paper.
2.1- If you die or retire you will continue to pay cash money to maintain these records for 10 years. Or you will pay the purchaser of your practice in the form of a concession on the sale price of your practice.
3- ANY software for managing the stored paper is fine, as long as you can retrieve it when needed. We use "Capture Perfect" because it was free with our big Cannon scanner when we bought it.
4- SCANNED records are available anytime you want to sit down and page through them. Thank God it is true that this is a very rare event. Agree that a patient gone for 2 years is not likely to come back too often. (I do see that, but it is not a reason to save charts.)
5- the paper charts that you are paying to store will likely only be of interest or use to the plaintiffs attorney.
6- You must give your staff the tools to do the tasks you have assigned them. We dragged our feet for a pitiful 6 months buying only one extra scanner because we thought when the charts were all gone we wouldn't need more scanning capability than we already had with the multiple 'all in one' printers that are in the office. Finally we bought TWO more high speed scanners because staff were waiting in line for the two we had. The return on investment is probably measured in 3-4 months just on the salary of staff working at a lower potential with inferior tools.

So I still say, for RuralPeds, just scan the old records into AC and shred the paper. Be done with it. If you have a larger bulk of paper than I envision you might use a second system for old charts, but I don't think you have that many. (Leslie does, but she just doesn't want to face the task ahead! :-) )

Agreed completely.

Leslie,

It's the danger of the lease. The lease on the machine, which sells for much less than the retail price states, is the same as the lease on our Muratec. Of course, it's longer. But, if our lease and warranty ran out on the Muratec, we would be paying each week to have paper pulled out of its gills.

The Toshiba is sold by the same company here in town, and should improve things quite a bit.

Martin,

You are absolutely right...I dred facing the task of scanning everything and letting go of the security of my paper cahrts with all the different colored paper and pretty little file tabs. Also, there is definitely a learning curve for staff and, like me, not one of them even knew how to turn on a computer a few years ago. So, we learn as we go. But, once my newest employee gets her jobs down comfortably, I may begin to make more movement towards paperless.

Leslie

I read something once that was pretty funny and most likely dead on. It said you could go to any of these EMR companies, probably including Jon's, which tout the "going paperless" as one of the huge benefits of their EMRs, and none of them will be paperless. They will have paper everywhere.

What do you think?

We scanned our last paper chart yesterday.
I think I'll post my final Blog of a Newbie, reporting this milestone. It only took us 4 months to scan over 2,000 charts.

Now we are "paperless." I still print the lab requisitions everyday, multiple times per day along w/ Rx's.

However, we use MUCH LESS paper, as in $100's per month less (considering copy costs, toner, paper, wear and tear on the Muratec scanner).

We are using more paper than ever, but it is going home with the patient as we print copies of labs, pages of instructions and the summary of todays visit as we move toward greater transparency in a medical home model. Dave Connett brought it to my attention that there are different laws, (Federal) regarding different charts. I was ignorant that all Pediatric charts must be kept 18 years and medical records of any patient with any potential industrial exposure for silicosis or asbestoses (and others) must be kept 30 years. Yikes!

Martin,
Now are you dead sure about this? Wow is right. I sure wish your friend was wrong, real wrong. Oh my goodness....

No I am not dead sure. The guy who told me is credible. But I wasn't sitting with him, looking in a book of statutes. He is the Dean of Clinical Rotations at Western University and seems a credible guy with no reason to be wrong about this. He seemed dead sure.

Unreal. So 20 years after anyone of you is dead your estate will still paying to preserve and copy your old patient files. With laws like this, that compensation in selling a practice is going to have the retiring doc paying a "ransome of redchief" to the new doc coming in.... Wow!

What I think usually happens is that you pass this on to the one who buys the practice or you find some lucky soul, (we have done this) who will take your old records in exchange for any patients that might show up. But you do have to do something.

My plan is (if I ever become totally paperless) is to put all my data on CDs or the like when I retire. Then, when I die, there will be strict instructions to put the CDs in the coffin with me. If anyone wants the records, they will just have to come get them.

Leslie

What will usually happen when a phyaician dies, is that the staff/office manager will literally give the entire chart to the patient, who then has the responsibility to find a new doctor and take their chart w/ them.

In the same manner, the AC records/.PDF Import Itmes files can be either emailed, faxed or burned to CD's and given to patients.

I must disagree with Leslie's idea. Burying your recordsw/ the physician is not the best means of preserving the integrity of your records. Rather, I would prefer burying them on a uncharted paradise island in the Caribbean. Create a treasure map and pass this out to your patients. If you really want to screw the up the patients who are delinquent in their bills, give them a treasure map that leads to a billing statement. Attach to that a note saying, "Pay up your bill, then we'll give you the correct coordinates of your records."

Thanks for the inspiration! I think I'm going to leave these instructions for my staff in my will

I am not dead sure, but at least in Maine, I believe you have to keep pediatric records until 18 + 6 or something crazy like that.

Here's the great thing about EMR's. We can all just keep our records for the rest of our lives. And it only takes up Megabytes on a tiny hard drive. No need to worry about how long to keep records, because we can keep them forever at no real cost.

Sure Adam, sure. Remember all the ASP stuff we discussed??? There are those who would like to have us all on various taximeters for the rest of our lives, not just until you guys retire. And even if you do own and possess a legal copy of your software, program there are things like changes in OS, upkeep and all the rest. Yes I think all of us here see this as the way to go, but nothing has no cost at all. These "E" records are certainly going to cost us even after we close just to keep them humming along.... Just in case.