Scanned patient charts ease preparation for EHRs

Michael J. Dolan

As I began considering what I needed to do to prepare for my practice’s conversion to electronic health records (EHRs), my first consideration was how to handle my countless paper charts. I spoke with a number of practices and EHR companies and found as many different opinions as there were offices.

Do you pull charts before the first visit and scan them prior? If your practice is like mine, you will be pulling charts for the next 5 years as patients slowly trickle in.

Do you scan only information you need after the visit? This would involve my time sorting through charts and making decisions. It would also involve expensive and valuable staff time.

I asked why I could not just scan everything. I got answers such as: “It would take too long,” “It is cost prohibitive,” “It would take up too much hard drive space.” There are companies you can hire to do this, but I was afraid of the costs and involving outside individuals.

Scanning, organizing patient records

I decided to experiment to see what it would take to do this in-house. I first purchased a high quality Fijitsu scanner capable of scanning up to 25 double-sided pages a minute.

Next, I had to decide on the format (PDF, TIFF) in which to scan. The scanner came with an Adobe Acrobat Standard program capable of creating PDF files. I decided on PDF because of its compatibility with most EHR programs and file sizes.

You can purchase programs with which to scan and organize files. Frankly, they confused me and can be expensive. So, I created my own system. I went under “My Documents” on my desktop, right-clicked and created a folder called “Patient Records.” I then created 26 subfolders from A to Z.

My charts are split into four areas: exams, contacts, optical and correspondences. Under Z, I created 25 more subfolders called “Master A” to “Master Y,” with each of my chart areas under them. From this point it is just a matter of copying and pasting to create a block of 25 new folders. The blocks of 25 make it easy to count.

The folders are then renamed to the patient name in this format: last name comma first name. I added dates of birth for two patients with the same name. This is very easy and goes fast. It is best to start at the end of the alphabet. When scanning, files are opened in alphabetical order and the newest files appear at the beginning of the list, making them easy to find.

Time commitment, hard drive space

The next step was the most difficult. I chose a rainy day off and brought home a few hundred patient charts. I spent eight hours scanning. This was important because it enabled me to find where problems arose and allowed me to see how fast I could scan. It also gave me an idea on how much I would pay someone. Once I had several hundred charts scanned, I determined the amount of space it would take on my computer.

I found I could easily scan 25 to 30 charts per hour. If I scanned patients from 2004 on, that would be about 10,000 charts for my office and would take about 10 weeks. I decided that I would pay someone 65 cents a chart or about $6,500 to never have to pull these charts again. If I chose 200 DPI resolution, it would take 4 gigs of hard drive space, which is nothing.

I hired a few college-age relatives of my employees. My accountant said that they could be classified as independent consultants, which means no expenses, taxes or unemployment. They must be able to create their own hours. Check with your accountant.

I set up a separate room in my office and photocopied an example of each form they will encounter and taped them on the wall under the category in which they will be scanned. During the day, they would take about 25 charts at a time to be scanned. They clearly marked the front of the file to identify that they were scanned. The office staff must not file anything in these marked charts without rescanning the new items.

Benefits without EHRs

A year later, I am still waiting for my EHR to be released. What I learned over the past year is that I wished I had done this years ago. The benefits are numerous, even without EHRs.

Chart preparation is easy now. Blank exam forms are printed off and placed in a generic chart and they are ready. In the exam room, my technician calls up the patient files prior to me entering and then minimizes them to the bottom of the screen. It is easy for me to click on these files and review past visits without shuffling papers. Patients are impressed.

When I am done with the patient, my staff member that was responsible for filing charts scans the new exam form to the patient’s file. The forms are then placed in a file cabinet alphabetically and by date. It takes no more time than filing. If I ever need these again, they are easy to find. Not once has the office been turned upside down looking for that misfiled chart. Now, if a patient calls, my secretary clicks a few times and has instant access to any chart without placing the patient on hold to find the paper chart.

Adobe Acrobat Standard – which I recommend that you purchase for all key computers – has a tool called “typewriter” that allows a note to be added to any scanned file, making documentation easy. I now take a few minutes at the beginning of the day to review my follow-up medical/glaucoma charts to refresh my memory, saving me time in the exam room. I also select some patients that I can have dilated without affecting my exam prior to my seeing them. Charts can easily be accessed from home. I can only imagine the benefits if I had a second office.

All my scanned charts have been moved into the basement, creating more office space and much less clutter. No one in the office would go back to pulling charts.

Optometrists must take steps to advance themselves and keep pace with medicine. Electronic health records are in everyone’s future. Scanning prepares you for this step and makes the conversion easier. You will be amazed at how ready you will be for EHRs once you are accustomed to looking at a computer screen rather than paper.

Even if EHRs are not in you near future, this will still make your life easier. I am sure that everyone has a scanner of some sort in their office. It costs very little to give this a try. There are many ways to do what I have done, but this approach worked for my office.

Editor’s Note:

This article contains examples of excellent execution of an idea that reflects the quality of the author as a manager of his practice: reducing the complex to the simple, testing the idea, creating a system, executing with leverage (part-time, lower-cost labor) and citing the benefits that were intended as well as those that were a surprise to staff and practitioner. While this may be a stop-gap measure for the author, it is a great example of implementing an idea and reporting its value.

Jerome Legerton, OD
PCON Practice Management Editor

For more information:

• Michael J. Dolan, OD, can be reached at Geneseo Family Eye Care, 4384 Lakeville Rd., Geneseo, NY 14454; (585) 243-2020; fax (585) 243-1372; e-mail: mjdolan@frontiernet.net.