Friday, May 7, 2010

Paper Patient Charts in Remote Practices

As hospitals continue their EMR implementations, they often recognize that they need to address the paper that's in their remote clinics and practices:  ie what to do about the paper patient charts in the practices? 

In brief, the following are commonly used:
  • do nothing - leave the paper charts at the practice
  • pack and ship the charts to a central scanning and indexing facility (often at the hospital or nearby and sometimes a third party that specializes in scanning and indexing)
  • use staff at the practice to do the scanning and indexing
  • send a mobile team to the practice to do the scanning

My preference is the mobile scan team and here's why. 

Scanning is Process Manufacturing
While scanning and indexing isn't really hard work, to do it well requires people that like to do it.  Think of scanning as process manufacturing that starts with raw materials (a paper chart) and after processing produces perfectly indexed images inside of an EMR system.  The process includes
  • document preparation - removing paper from the chart, taking out staples and paper clips, repairing paper tears, and taping small pages to 8x11.5 paper.
  • batch preparation - insert document separators to segregate individual documents.  The most common technique is to use barcodes to identify each document type (progress note, lab result, discharge summary etc)
  • scanning - feeding batches of documents through a scanner
  • indexing - adding attributes to each of the documents such as MRN, Date of Service, Provider ID, Facility Code, etc
  • QA - confirming that the image quality is acceptable
  • commital - sending the documents to the ECM system
People that like to do document preparation are essential to creating high quality images in the EMR while people who take pride in their accuracy will prevent misfiles and rework.  Do you have those kinds of people at your remote practices with the time to do chart scanning?

Scanning Requires Specialized Equipment
While the price of scanners has come down, there remains a significant price for performance. Here's how to think about it: if the scanners is running, then paper charts are being converted to images.  If the scanner breaks down, charts are not converted.  My recommendation is to always buy 2 scanners and as operators become proficient whith those scanners, keep the scanners running.  Let the rate at which the scanner scans become the throttle to your process:  add staff to document preparation and indexing / qa to accomodate the throughput of your scanners. 

Additionally, you'll likely want to have tools that make document and batch preparation more efficient such as "spear-type" staple removers, solid scotch tape dispensers, document and batch separators, and so on.

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