The paperless office is a misnomer! There is a constant flow of paper into every medical practice from multiple sources including hospitals, consultants, and other non-automated service providers. In many cases, clinical information is digitized in the form of Word documents and other digital formats printed and re-digitized by scanning the documents into the EMR. In the distant future, medical practices may become completely paperless when all data and documents are delivered electronically into EMRs or are transmitted from EMRs through information exchanges to other parts of the healthcare system. In the present state, we could aim for paper-light offices at best, by methodically reducing the amount of paper we receive and generate.
One of the greatest sources of paper is the volume of historical paper charts that exist in medical offices and storage facilities. As practices migrate from paper records to EMRs, many of the paper charts need to be partially or completely digitized and archived or incorporated into EMRs. What are the principles and guidelines that practices should follow in terms of scanning and archiving these records?
The advantage of the EMR is that once a practice has fully transitioned, there is limited need to access paper charts. They can then be moved off site, freeing up expensive storage space. However, records may need to be retained for legal purposes or based upon organizational/practice policies.
Some key questions arise regarding document scanning and retention:
- What is the best format in which to scan a document for inclusion in an EMR?
- Is there a required minimum resolution?
- What are the most commonly used formats?
- Is the size of the document (in Megabytes) an issue?
- Are there any existing legal requirements or precedents governing these guidelines?
As a basic principle, a scanned record needs to be non-editable. In other words, once it has been scanned, it must not be possible to modify the record or document in any way. In addition, the document must be readable. This is where the question of resolution comes in. The higher the resolution of the scan, the larger the file. So there is a trade-off between document size and resolution. But is there a minimum that is acceptable?
In order to optimize integration of documents from external sources into EMRs received via fax, if you are not currently using a fax server, this should be a top priority. Click here for more information about fax servers.
In terms of scanning, Adobe Acrobat (.pdf) and Tagged Image Formet (.TIF) seem to be the most common formats that are easily readable. Are there any other formats that practices or EMR systems are using for scanned documents?
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