The costs of EHR software and hardware are currently front of mind due to the Medicare and Medicaid incentive funding programs that are now available to practices that wish to adopt an EHR. However, it is easy to lose sight of the fact that the most valuable parts of a patient record are the clinical data, reports and results that are painstakingly entered into the chart by clinicians and staff over extended periods of time. In order to maximize the benefits of your EHR, you will need to pre-populate the electronic chart with important clinical and demographic information. The following simple steps will improve your successful transition from paper charts to an EHR.
The conversion of existing paper charts during EHR implementation is routinely seen as one of the greatest barriers to EHR implementation. Chart conversion is a time consuming and resource intensive task that many physicians view as a hellish purgatory of pain. In addition, ineffective and expensive chart conversion is one of the most frequently cited reasons for the failure of EHR implementations. However, there are several things your practice can do to help shorten and reduce the pain of chart conversion.
When selecting an EHR, your practice may be completely paper-based or you may use a practice management system to schedule your patient visits and manage practice billing and reimbursements. If you use a practice management, your choices are to keep that system and implement an EHR that has been designed to integrate with the PM system, or you may decide to transition to a completely new system that combines both practice management and clinical documentation functions. Each of these transition strategies requires careful planning with respect to paper chart conversion.
Develop a plan that both indentifies the process you will use to capture the information from your paper charts and establishes realistic time frames within which to complete the process. You should take into consideration the data that is most frequently going to be clinically relevant in the treatment of your patients. One of the most common mistakes is to attempt to input the entire patient chart into a new system. This is an understandable instinct given the effort most clinicians put into maintaining their patients charts, but tends to be extremely expensive and can end up corrupting the data in the new system.
Data you will most frequently need:
- Current problems/conditions
- Current medications (Episodic and long-term meds)
- Past medical and surgical history
- Important diagnostic results, e.g. Lab results, pathology or most recent EKG
- Screening test dates/results
- Advance directives
There are several strategies available to you for conversion of this information including scanning in the documents in .pdf format. The pros and cons of these strategies are well explained in an article on chart conversion from the California Healthcare Foundation. Click here to download
The following tips are provided to assist you when developing your chart conversion strategy:
- Review and update your paper charts prior to implementing your EHR. Irrespective of which EHR you choose, you will need to get your charts ready for data input. Having the updated clinical data organized using a standardized face sheet will streamline your data entry process when you populate your EHR.
- If you have more than one physician in your practice, it is crucial that you agree upon a single standard paper template to collect this information. This will allow data entry clerks, administrative staff and physicians to pre-populate summary information by using template-based chart forms that capture data in a more structured manner. This makes the data you may want to transfer to your EHR more readily accessible and faster to move to your EHR. It also gets you and your practice used to documenting your patient visits in a structured manner that will likely be similar to most EHR systems. The American College of Physicians has several forms to assist you. Vaccine template (.pdf), Summary form (.doc), Med sheet (.doc), Flowsheet medications (.doc)
- Identify patients that are seen regularly in your practice with chronic medical conditions or complex care problems. In a primary care practice, these patients may comprise 10% to 30% or more in specialty practices. However, getting these paper charts organized and entered into your EHR as soon as you begin readying your EHR will allow you to focus on the clinical encounter when you see that patient in your clinic. It is much easier to have all the complex patient data pre-entered, which will allow you or your staff to enter less complex patients on the day they are seen or during the clinical encounter.
- If you choose to scan all of your old patient records, you will then be able to move any remaining paper charts off-site and will be able to reclaim space used for chart storage and utilize that space for other purposes such as additional examination room(s). If scanned into a compatible format (e.g. PDF), a copy of each scanned patient record can be attached in your EHR allowing for quick review of the paper medical chart if needed.
- Should you choose to maintain an existing practice management system with a new EHR, you will need to ensure that patient demographic information from the practice management system is available in your EHR and that the systems work seamlessly with one another.
- When choosing how to enter the data, remember that discrete information such as immunizations or labs, if entered as a .pdf or TIFF file, will not populate any of the data fields in your EHR. As a result, any alerts or population reporting tasks in your system will not be reflected in this data.
- Establish a definitive goal to keep everyone in the practice motivated. One of the most effective strategies is the “three time rule” where the physician is allowed to use the patient’s paper chart only three times (three visits) before the paper chart is retired. At each occasion the clinician can enter data and flag any results they want entered or scanned. This approach is explained in more detail in the CHCF article mentioned earlier.
- Finally, ask your EHR vendor for recommendations regarding the preparation of your paper charts in order to make the process as efficient as possible. You do not need to enter all of the clinical information into your EHR as discrete (searchable) data. In fact, once you have followed these steps and have your charts ready for data entry, you should be well positioned to begin your EHR implementation. The added benefit is that while time-consuming, you will also have a chance to do a detailed review of each patient’s important clinical information as you update his or her medical record.
This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.