To the Editor:

I enjoyed reading Dr. William Soper’s “Why I Love My EMR” [October 2002, page 35]. I would like to ask Dr. Soper how he incorporates the multitude of paper reports (consults from specialists, lab reports, X-ray reports, etc.) into the EMR. What type of scanner does he use, how much manpower is devoted to scanning these documents, does he destroy the paper once it is scanned and are there any legal issues surrounding this? These appear to be issues that could make the EMR less efficient.

Author’s response:

Scanning is a critical function of an EMR system. We scan letters, X-ray reports, lab reports, insurance cards, copies of driver’s licenses, Medicare ABNs, faxed refills, patient thankyou cards and anything else that we would have charted or filed before. Although reports and letters could be electronically signed off by our providers after scanning, we’ve found it more practical to have the paper copy initialed before the document is scanned. We save no paper.

We use a small, automatic-feed Fujitsu scanner that cost about $800 three years ago and has scanned several hundred thousand documents so far. Typically, scanning images and digitally attaching them to a patient’s record requires one to two clerical hours a day for our three-provider practice. We have a heavy-duty shredder ($400) and shred all the paper after scanning. I’ve considered using a shredding service and may go to that some day.

I am currently enabling a link that will let us electronically sign and transfer faxed material directly into the EMR database. Currently, we’re printing faxes, scanning and then shredding them. The only legal concern I see would be the need to avoid optical character recognition software. Some of these programs allow a scanned report or letter to be altered within the system.