Best Practices — Converting from Paper to EMR

Converting paper charts during EMR implementation is generally seen as one of the greatest barriers to switching over a practice. Chart conversion is a time-consuming and resource-intensive task; however, there are several things your practice can do to help shorten and reduce the pain of chart conversion. In order to maximize the benefits of your EMR, you will need to pre-populate the record with important clinical and demographic information. The following simple steps will improve your successful transition from paper charts to an EMR.

Develop a plan that both indentifies the process you will use to capture the information from your paper charts and establishes realistic timeframes within which to complete the process. Consider the data that is most frequently going to be clinically relevant in the treatment of your patients. One of the most common mistakes is to attempt to input the entire patient chart into a new system. Not only is this expensive, but also it can end up corrupting the data in the new system.

Data you will most frequently need include the following: allergies, current problems, current medications (episodic and long-term meds), past medical and surgical history, important diagnostic results (e.g. lab results, pathology, or most recent EKG), consult letters, immunizations, screening test dates/results, and advance directives.

Here are some tips and best practices for chart conversion:

• Review and update your paper charts prior to implementing your EMR. Irrespective of which EMR you choose, you will need to get your charts prepared for data input. Organizing the updated clinical data using a standardized face sheet will streamline your data entry process when you populate your EMR.
• If you have more than one physician in your practice, it is important to agree upon a single standard paper template to collect this information. This will allow you and your staff to pre-populate summary information and makes the data you may want to transfer to your EMR more readily accessible and faster to input into your EMR. It also gets you and your practice used to documenting your patient visits in a structured manner that will likely be similar to most EMR systems.
• Identify patients who are seen regularly in your practice with chronic medical conditions or complex care problems. Getting these paper charts organized and entered into your EMR will allow you to focus on the clinical encounter when you see that patient. It is much easier to pre-enter all the complex patient data, which will allow you or your staff to enter less complex patients on the day they are seen or during the clinical encounter.
• When choosing how to enter the data, remember that discrete information such as immunizations or labs, if entered as a .pdf or TIFF file will not populate any of the data fields in your EMR. As a result, any alerts in your system will not be reflected in this data.
• If you choose to scan all of your old patient records, you will then be able to move any remaining paper charts off-site and will be able to reclaim space used for chart storage and utilize that space for other purposes such as additional examination rooms. If scanned into a compatible format (e.g. PDF), a copy of each scanned patient record can be attached in your EMR allowing for quick review of the paper medical chart if needed.
• Establish a clear goal to keep everyone in the practice motivated. One of the most effective strategies is the “three time rule” where the physician is allowed to use the patient’s paper chart only three times (three visits) before the paper chart is retired. After that point, the chart is still accessible, but — as a deterrent — some practices charge each physician a small fee per chart.

Have you converted from paper charts to an EMR? Share your experiences by clicking on the “Comments” link below.

Comments

[M Luxton]

One thing not considered by most is what happens if your EMR reaches an end of life event such as buyout and you don't like the new service, goes out of business, etc. You need to also factor in "how do I get my records back out if company folds or I want to leave them, and how portable and transferable is that info?" Evan in Alberta, with the folding of the Physician Office System Program in Mar 2014 and the provincial MSA along with it, there will no longer be a requirement for even the former participants in the subsidization program to support the provincial migration (export/import) standard, returning it to the shoulders of the custodian to make sure their chosen EMR vendor has the ability to bulk export charts in a usable/migratable format, preferably with that capability in the hands of the clinic, not the vendor, as happened with Rise Perk. In cases where this was not planned for, I've seen clinics with 3-4 servers running with legacy EMRs to keep from losing data because they can't get the old data out (or can't afford to or old vendor is holding it hostage and not willing to get it out for them).