Five things to do with your old paper medical records

This is the transcription of my discussion with Mark Anderson, CEO of the A.C. Group, Inc, discussing "Five things to do with your old paper medical records". You can listen to this interview by clicking on the YouTube play button below the first couple of paragraphs.

Robert Gleeman: We're talking today with Mark Anderson from the AC Group. Mark Anderson's phone number, in case you want to give him a call, is 1‑281‑413‑5572.

Thanks for being with us again today, Mark.

Mark Anderson:  Thank you for having me come and speak again.

Robert:  Our subject today is "Five things to do with your old paper medical records" and I assumed that burning in a public bonfire is not one of them. Is that true?

Mark:  That is one of the options but not one that we would recommend doing.

Robert:  Well, why don't we go through these one by one and if you would, let's start out with number one.

Mark:  Well, if you'd look at most practices, like the average doctor has around 5,000 active charts, and what the vendors usually recommend option one is just scan everything in. It's amazing where a lot of vendors are telling people that you have all these medical records information and one of the ways of reducing cost is to give it over to your chartroom. Some doctors have actually gone back in and taken all their old charts, pulls them out and actually scan them directly in as a PDF file into the EMR.

The vendors recommend that once you go back and look at the cost taking all those charts, scanning them all in, and storing it in your EMR, there's heavy cost for the labor to scan everyone of those documents in. Yes you do free up that space, but if you're not going to use that space for revenue‑producing new activities, there's a lot of cost added in. So a lot of doctors think about scanning everything in, then they come back and say, "There must be a better option. Maybe I can just scan parts of the information in."

Robert:  Does that lead us to number two?

Mark:  Yes. I think what it does to make a little bit more sense is a partial scanning of your paper charts. A couple of things to remember, when you scan the document in, there is no data. You're basically looking at a piece of paper. So if you want to go back and say, "Give me all the patients that are on a certain medication or have a certain lab result", you're not going to have that by scanning the information in.

So what most practices are doing‑‑and this is one of the options that are out there under option two‑‑is that they're going in and saying "Any new patient that I have coming in today or the next week based on your appointment schedule, I'm going to have a clerk, pull that chart like they normally would do, then they go on and either scan the whole chart in based on that appointment or they will decide based on the specialty what pieces of information are important to my practice?"

A lot of times the doctors will say, "Give me the last three lab results, the last three office visit notes, and any other basic procedure that may go on and have that brought in as a scanned in document."

Robert:  In the second scenario, what percentage of the charts would typically be scanned?

Mark:  Obviously, it always depends on the specialty. If you go back and look at a typical family practice physician, there's a lot more of that chart that they want to have they classifies as clinically important. So in that case, you may see 40% or 50% of the chart maybe scanned in. If you go back to another specialist, maybe a dermatologist or let's call an orthopedic surgeon, you may only want to be scanning in relative information that taking care of the current injury that you're taking care of the patient for.

Robert:  This leads us to scenario number three.

Mark:  Well, I think these are looking at scenario number three. It's really going back and saying, "Can you find a way of summarizing the charts in a‑‑what lots of doctors are calling‑‑a patient's summary page?" A typical patient's summary page is a one or two‑page document that's usually on the very front of the chart that has on it information about the diagnosis of the patient, what labs that they've had, what medications that they're probably on. Then maybe you just scan in that one piece of paper or two pieces of paper about the patient. The value there is maybe the patient doesn't have an appointment to come in yet, but they call up about a medication refill.

With your typical EMR, until that patient's been seen, there's no data in the computer system at all. But in this case, where the patient's calling in and you scan in that one or two pages that summarize everything about the patient, the doctor can then pull up, see who the patient is, find out what active meds they're on, or when was the last time they've been seen?

Enough information where they can actually help the patient without having to tell the patient to call back later or have somebody run and go find the chart every single time. We found by having a summary page, you can cut out about 80% of the chart pulls that are necessary‑‑again, so many doctors established what they call as "clinically important information" and have that summarized in an analyzed form on the actual chart to start with.

Remember, you can always go back in‑‑if it's a very active page of multiple diagnosis issues‑‑you can always go back in and scan more pages in or the whole chart if you want. This is probably where the highest level of adoption is where the doctor has a summary sheet and then maybe they actually will highlight the last three lab reports you also want to have scanned in.

What you're doing is really limiting the amount of scanning that you want to do on active patients by having a one sheet or two sheets that really summarizes on maybe two or three pieces of paper that are clinically important that you really can't put on a summary sheet. We're saying about 80% of the doctors are embracing that kind of technology right now.

Robert:  Interesting.

Mark:  Option four is where the doctor sees the patient with the paper chart today. They see the patient, they put new things into the EMR, and then what they do is they go back to the old note and they may put a little sticky note on that chart stating that these are clinical important things that you need to have pulled and scanned in after the visit. They may go in and circle things on the chart, specific data elements that they want, maybe their nurse or a clerical person to enter in those discreet data. So we think option four is probably the best way to do it today.

Robert:  And there is an option five. What is that?

Mark:  Option five is an interesting approach because most doctors today are very busy in their practices and their staff doesn't have a lot of extra time to scan charts. Option five deals with hiring an outside firm that can come in and they really do two things. One is they review the chart and they can scan pieces of paper in for you. But a lot of these companies also can go to review the chart and do a lot of your data entry for you.

So they can actually be your interim nurse or MA who goes through, reviews all your active charts‑‑maybe patients are coming in the next week‑‑and they spend the time scanning the documents in and putting in discreet data into the EMR. Of course, there's a cost applied to that, but in most practices, again, we find that they do not have enough time to do their normal work, learn how to use the EMR, and scan the documents in especially during that first six months.

Robert:  At what point can you actually get rid of the paper files and destroy them?

Mark:  Well, we always say to always check you're state because each state has a little different requirements. What traditionally everybody looks at, you have to keep any patient that has been active in your practice for seven years over and above the age of 21. So anybody that's been in your practice‑‑maybe they were seen when they were five years old‑‑you have to keep that chart active until they're 21.

Robert:  Mark, of the five options you've mentioned, which is the most cost‑effective?

Mark:  I think the most cost‑effective method right now is that we talk about as far as option four, the one where the practice sees the patient with the paper chart, records what's important for them, maybe put a sticky note on the documents that they really need, and then the staff basically‑‑instead of refilling that chart later on‑‑they take that chart, scan in the specific data that's important and you may file it offsite.

You won't need it again for a while. That way the staff, instead of spending the time refilling the chart is basically scanning it in so there isn't a lot of additional cost for doing it that way. We think that's the most effective way of hauling the old paper records today.

Robert:  Very interesting, thank you very much, Mark Anderson, AC Group. Thanks for being with us today.

Mark:  Thank you.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.  

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist 
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX  77316
(c) 281-413-5572
(f)  832-550-2338
email: mra@acgroup.org
web: www.acgroup.org