October 2014

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Comments

Samuel Bennett

This is a very interesting comment that I will publish on behalf of a vendor of a scanning application. Samuel Bennett has included a disclosure statement and I believe that this sets the stage for a very interesting discussion. Whether there is value to the pure scanning of patient charts that are stored on a CD or DVD or if this needs to be done as part of an integration mechanism with an EMR.

Please read the comment following this one for my thoughts on this subject. (Ed)


"(Disclosure: I'm a co-founder of an appliance that bridges the gap between paper and electronic records.)

Obviously, I think it's reasonable and logistically possible to scan the entire contents of a chart room. This is how we empower practices. Getting paper charts into a digital format is important, but requires some forethought.

For example - you've scanned all of your charts onto several DVDs. When it's time to retrieve a specific chart, how do you put your hands it quickly?

I believe that the scanned chart has to be as closely integrated with an electronic medical records system, however primitive. If possible, the individual sections of the chart have to be available within a few clicks. Otherwise this information has a high degree of obsolescence. Simply, it won't be used because the cost of retrieval is too high. In my opinion, scanning to DVD or hard drive for pure storage is worse than the paper chart dilemma.

It's worse because this information isn't extensible, meaning there's no way for the digital systems of the present and future to hook into this data for retrieval or sharing. Until a true standard emerges for electronic medical records, this is a sticky proposition."

Alan Brookstone

I believe that Mr. Bennett is confusing two issues. The importance of information being extensible so that digital systems of the present or the future can hook into the data for retrieval or sharing is not in question. Ideally, one should be able to scan documents so that they are integrated directly into an EMR system or can be flagged to ensure that they are identifiable by digital systems.

The issue that I think a number of practices are currently facing is what to do with thousands of paper medical records when one closes down a medical practice and either has to physically store those charts or has difficulty in transferring the charts to another physician or practice because the practice either has an EMR system and would prefer a digital file to append to their new patient record or the practice is already overwhelmed with paper records and does not want any more paper.

As long as the (entire) scanned patient record is identifiable through a name, medical record number and/or date of birth, it should not be difficult to find the appropriate record and copy to a CD to send to the new practice or send via secure e-mail.

I am not sure that extensibility is that important in a situation where a retired physician is faced with thousands of dollars per year in storage and chart access fees.

Thoughts?

Angus Chan

There are a few issues to be aware of when storing/archiving electronic medical records: Lifespan of the media used, and the longevity of the format being used.

DVDs and other storage media have been known to decay - someone needs to ensure that the data can always be retrieved. Also, in 5-10 years who is to say that the Media can be read anymore? It's difficult at the moment to find floppy drives these days.

Secondly, although PDFs are the defacto standard today, it may not be in the future; it may be difficult to locate the software required to read the files in question.

Michelle Greiver

I actually had all my paper charts scanned and then shredded. I look at the paper chart as Part A and the EMR as Part B of the record. This came from an article by Dr Mark Dermer, and I think is a good way to think of the chart.

I bought an external hard drive ($150) and a DVD drive ($100). A student scanned the charts over the summer, into two parts named lastname, firstname clinical and lastname,firstname lab (about $1,500). The Clinical is the CPP and all handwritten notes. The Lab is DI, labs, consult notes etc. It was backed up to 2 DVDs, one kept at the office, and one locked at home. All files are in pdf format. About 70% of charts were scanned and shredded over the summer, and my staff did the rest slowly over the next few months.

As the EMR progresses, I look at the archived charts less and less. If I do need something, I can access the chart over the internal network which was set-up by the IT experts for me. Looking up the chart is easy (windows alphabeticized them in the folder, I just type the first letters of the last name). Then I load the pdf. I click on the "pages" tab on the left, and I get these thumbnails of the pages. Locating the last DXA, for example, does not require much work, just scroll down the thumbnails.

If we need to transfer a paper chart, it is copied to CD ROM and mailed. I'd be happy to send it electronically in the future, but mailing a CD ROM is really not that much bother.

I'm not an expert on DVDs deteriorating or pdf being unusable years from now; I downloaded and keep a spare copy of Adobe reader in the DVD just in case. If the experts tell us that Adobe Acrobat Reader is not good enough, that is pretty worrisome; incoming non-electronic data going to the EMR charts is scanned to pdf. I would doubt that this will be allowed to go obsolete due to the amount of information kept on pdf nowadays, but that is just my opinion.

The cost of scanning and shredding was under $2,000 for a 1500 patient practice. That includes all active, transfered, inactive and deceased files. Total was 20 gigs of data. It accelerated the transition to EMR, because paper charts were no longer available. I sold my filing cabinets--more office space.

At up to $400 per month to store charts for a physician who is retiring, scanning and shredding makes a lot of sense. Just buy a good scanner and a really good shredder, or get a reputable company to do it for you.

Michelle

Alan Brookstone

The following is posted on behalf of a vendor that provides a chart storage service for physician practices.

"I feel that this article ignores the option presented below which would be valuable and relevant information for readers.

This article ignores the option of Specialized Medical Record Storage companies that provide secure, compliant storage of your records (paper, electronic or both). As part of the service, these companies will provide copies to patients at a reasonable cost (which is capped at a maximum fee), send a letter to patients informing them that the practice is closing and pay for a reference of call on a medical practice office phone."

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