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#33014 - 07/25/11 08:20 PM paper and EMR
nateb Offline
Member

Registered: 02/05/05
Posts: 95
Loc: Augusta, GA
Question? does anyone use paper charts AND an EMR with varying mix of both ? Somethings won't go into an EMR, but you still need to keep track of it. Or older medical charts that can stay paper as you transition to EMR ? Are there Medicare or private insurance standards that preclude the use of both for the same pt?
What do yall think?

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#33026 - 07/25/11 11:39 PM Re: paper and EMR [Re: nateb]
Greg Phillips Offline
Member

Registered: 03/04/05
Posts: 213
Loc: Coronado,CA
Originally Posted By: nateb
Question? does anyone use paper charts AND an EMR with varying mix of both ? Somethings won't go into an EMR, but you still need to keep track of it. Or older medical charts that can stay paper as you transition to EMR ? Are there Medicare or private insurance standards that preclude the use of both for the same pt?
What do yall think?

After 4+ years I still have my belt (paper) and suspenders (EMR).
I carry a paper chart into the room and then write the notes in AC and print them out to place in the chart. Labs and other reports also go into both places.
Yes, I know it is double work and the paper chart takes up space, but I am comfortable with this system and presently have no plans to change.
The only confusion has been when an outside agency wants to review the "chart". Usually we just give them the paper chart, but I feel that my documentation would include both if challenged.

Greg

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#33040 - 07/26/11 03:10 AM Re: paper and EMR [Re: nateb]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1809
Loc: Central Florida
Don't do both. Get a good scanner (hint, Fujitsu SnapScan) to input paper docs and/or an incoming paperless fax management system (Updox or PaperPort) for incoming docs, use the AC message system to document phone calls and other communications within the office. Eventually either scan old charts onto your server as reference PDFs or just retire them.

You are doing yourself a favor...do you realize what its costing you to keep two sets of records? Do your staff a favor...their future employability depends on being to function in a paperless office. Do your patients a favor...you can access their full record over the internet, and provide electronic documents to other doctors.

It took me 3 years to transition completely, so this will lessen the pain. But tell your office manger and staff it is going to happen, and their jobs depend on it. (that will get their attention). My staff thinks their work life has infinitely improved from the days of copying, faxing, pasting, filing, etc.
_________________________
John
Internal Medicine

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#33042 - 07/26/11 03:24 AM Re: paper and EMR [Re: nateb]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9897
Loc: Brewer, Maine
I respect Greg's method, but we started with AC and printed out the notes for a week before we trusted it. Never used paper again.
_________________________
Bert
Pediatrics
Brewer, Maine

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#33056 - 07/26/11 01:34 PM Re: paper and EMR [Re: nateb]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1969
Loc: INDIANA, SOUTHERN
I used to print out all my notes also until I realized it was silly. Once I was comfortable with my back up plan I bit the bullet. All new patients had nothing but electronic records. Established patients were scanned in a scientific manner....the thin charts were done first, then the thicker charts of younger patients were done in entirety, then the thicker charts of older patients were done selectively...only the last two years of labs, consults, xrays, etc. Their encounter notes were already in AC. This discrimination left me with less than one rack of paper charts. I disposed of three other racks of charts. I cannot remember the last time I pulled a paper chart. I also finish my notes in the room, in front of the patient.
_________________________
Leslie
Hospital Employed Physician Who Misses The Old AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#33063 - 07/26/11 07:31 PM Re: paper and EMR [Re: nateb]
dgrauman Offline
Member

Registered: 04/07/10
Posts: 1512
Loc: Fairbanks, Alaska
For the first year, we pulled the paper charts and had them readily at hand but did not take them in the room unless needed. Then we stopped pulling them as we were rarely using them, but would go get them if something came up. Now, 18 months later, the information we really need has been imported and the rest is so dated as to be of little value, and we are going to batch scan the whole remainder over the next year or so. I have not found anything that absolutely needs to remain paper, although sometimes quite a bit of weeding is needed. Example: when we do a stress EKG we no longer save every strip, but select the few that give the information we need. What things do you feel need to stay paper, Leslie?
_________________________
David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands

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#33067 - 07/26/11 08:32 PM Re: paper and EMR [Re: nateb]
nateb Offline
Member

Registered: 02/05/05
Posts: 95
Loc: Augusta, GA
Thanx for yall's input.
What if you just pick a date and from that point foward everything chartwise would be EMR. Previously created paper charts could just be stored until needed. These paper charts then would be gradually eliminated. That would save you time and money from scanning old stuff into a recently created EMR chart.

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#33077 - 07/26/11 10:23 PM Re: paper and EMR [Re: nateb]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1969
Loc: INDIANA, SOUTHERN
Not really anything, David. We would have no place to put the paper if we had it.
_________________________
Leslie
Hospital Employed Physician Who Misses The Old AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#33089 - 07/27/11 02:25 AM Re: paper and EMR [Re: nateb]
dgrauman Offline
Member

Registered: 04/07/10
Posts: 1512
Loc: Fairbanks, Alaska
Leslie, I must have had a flashback from the 60's. I could have sworn your post said there were items that you had to keep as paper. I have no idea where that came from.
_________________________
David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands

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#33090 - 07/27/11 02:33 AM Re: paper and EMR [Re: nateb]
dklehmannmd Offline
Member

Registered: 04/13/09
Posts: 218
Loc: Fort Worth Texas
We converted the paper charts to the EMR by scanning them in as the patient came to the office ( or called for refill etc). The basic rule was "any chart that gets pulled from the cabinet never goes back" , it goes to the electronic file as an imported item in the patient's chart. This has ( over 2 years time) opened up two entire rooms that used to be used for chart storage. One is a new room for the nursing functions ( vitals, injections etc) which improves work flow for the exam rooms. The other new room is being used as a procedure room, again improving work flow. My rent is the same but my office is 30% bigger and feels nicer too.
The counters are cleaner, the staff doesn't do any of that old" where is the chart" hunt routine.
Let the EMR do its thing. It is better than paper.
_________________________
Deborah Lehmann MD
Gynecology
Fort Worth TX

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#33095 - 07/27/11 09:08 AM Re: paper and EMR [Re: nateb]
Marty_PA Offline
Member

Registered: 07/07/10
Posts: 651
I wish we were completely paperless in our office. I'm just waiting for the day when we can purchase our new computers and start scanning everyone in.
_________________________
Marty
Physician Assistant
Fullerton, CA

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#33097 - 07/27/11 01:18 PM Re: paper and EMR [Re: nateb]
Sandeep Offline
Member

Registered: 04/14/11
Posts: 1950
Loc: California
We're almost completely paperless. Haven't ordered ink cartridges in six months. Used to order every 2-3 months, 300-400 bucks at a time. The new server we bought is already paying itself off.
_________________________

Sandeep "Deep" Luthra | I.T. Systems Architect/Engineer
(760) 895-1390 Ext. 101 | sluthra@luthratech.com
http://luthratech.com | http://luthratech.com/blog

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#33101 - 07/27/11 01:27 PM Re: paper and EMR [Re: nateb]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1969
Loc: INDIANA, SOUTHERN
We do still use a paper superbill but then those are scanned in later. The patients fill out a paper history form and Hippa and registration forms but then those too are scanned in and destroyed. We do not keep a paper chart (active anyway) on any patient now. It took me over a year to make the conversion.
_________________________
Leslie
Hospital Employed Physician Who Misses The Old AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#33106 - 07/27/11 06:55 PM Re: paper and EMR [Re: nateb]
dgrauman Offline
Member

Registered: 04/07/10
Posts: 1512
Loc: Fairbanks, Alaska
I really like Deborah's approach. We were just so darned overwhelmed by the conversion process that we needed to minimize our chores. So, we're going to be a little slow catching up with you guys.
_________________________
David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands

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#33116 - 07/27/11 10:26 PM Re: paper and EMR [Re: Leslie]
Wayne Offline
Member

Registered: 10/27/04
Posts: 1788
Loc: New York, NY
Originally Posted By: Leslie
The patients fill out a paper history form and Hippa and registration forms but then those too are scanned in and destroyed. We do not keep a paper chart (active anyway) on any patient now.


We do this too. We still have a bunch of old paper charts to scan in and destroy though. Those silly file cabinets are taking up valuable floor space.
_________________________
Wayne
New York, NY
Hey, look! A Bandwagon! Let's jump on!

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#33142 - 07/28/11 04:16 PM Re: paper and EMR [Re: nateb]
rsag Offline
Member

Registered: 06/28/10
Posts: 120
Loc: Orlando, FL
As new patients come in, I also scan in the charts, however I do not scan in the complete chart.
I scan in the old problem list, the medication list, the growth charts, the last two physicals and the last 2 acute visits, the first and last of all consultant notes and hosp summaries, and most recent lab tests. (a core of what I would look at.) I scan this into the file assistant pro, so it does not clog up the imported folder.
I find that for most of the time , this is more than I need to look at and I retain the paper charts with everything else.
I also use a fair amount of paper forms to be filled out, which are also scanned in and then shredded - so no new paper goes into the paper charts.
_________________________
Richard
Pediatrician
Orlando, FL

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