Occupying vast quantities of space in your office are thick patient records containing years of office encounters, labs, studies, consults and various other sundry notes and paper artifacts.
While there are those that advocate scanning the entire paper chart into the electronic health record, the consensus of most offices that have been through implementation is that this is overly time-consuming and not necessary. There is actually no avoiding taking a somewhat fresh start with the electronic health record. Information such as problem list, social history, family history, allergies, past medical history and medications are discrete data that need to be entered into your electronic health record database to produce a useful record for the present and future.
With proper guidelines, most of this data can be entered by a non-physician in your office. However, many family physicians who have been through implementation find it useful to enter problem list, past medical history, procedures, referring physicians and medications themselves, getting a fresh look at the patient and accurate data.
If you have set up your implementation to provide you with sufficient, you should have time either before or during the office visit to do much of this. This is a significant amount of work and there is no sense sugar coating it– doing it properly the first time will pay enormous dividends for the second, third, and 30th time the patient is seen in the future.
Certainly there are some things such as immunization history, EKG, recent cat scans or MRI scans and possibly recent important consultation reports which can be scanned into the record. The provider can flag these items either before, during or shortly after the first or second visit. It should definitely be a goal to retire the paper chart at or before the second visit. The chart can then be stored off-site for retrieval if necessary.
An EHR Email Discussion List post from Dr. Kelly Locke, Basalt, Colorado, admirably summarizes the various ways physicians have dealt with this issue. The information below represent his summation of the issue.
Matt Levin, MD, Monroeville, Pennsylvania, says:
"My contention is that it's easier to scan almost all, store original, and then destroy per state law.
I'll be starting to scan to PDF format within the next one to two months, as I reclaim many 60+ year olds from my prior practice, and our space runs out. Ultimately, I plan to transfer these scans to the EMR when the new version of [my software] comes out and has a good assignment tool (import tool) for scanning. I will have a server for file residence, or disc or other computer for this to be sure I don't overstress the software."
There are different ways for a physician to approach entering his/her data. A break down as follows:
A physician may set a particular goal, say ten charts per day, to add to the system as time allows. If there are hundreds of charts, this becomes very cumbersome and the EHR program is only slowly populated. However, as the process becomes familiar, data entry is faster, allowing more charts to be done in the same amount of time.
This option calls for entering patient information as they come in for a visit. The chart is pulled for the visit and the physician or nurse can enter the data during the visit.
Susan Andrews, MD, Murfressboro, Tennessee, says:
"We found that extracting the information the first time the patient came in with EMR in use worked well. If you have a nurse who is good at it, let her do it, or the physician can do it. A combination can work as well. We did it both ways, and one doctor dictated with the transcriptionist putting it straight into the right part of the chart.
How it gets done is less important than getting the information in the right place. What code is picked is not that important either. The coding is for billing purposes, and having a slightly 'wrong' one does not impact patient care."
Pennie Marchetti, MD, Stow, Ohio, says:
"I'm doing it [this] way. It slows patient flow down if I do it during the patient visit. I was running up to an hour behind. Instead, I've been entering the old info in the summary field (problem list, med list, etc.) usually at lunch and at the end of the day on the day the patients are seen. It adds about one to two hours to my work day, depending on the number of older, complex patients I see that day."
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