August 10, 2010
Featured Article
Scan and deliver - records conversion made simple

The scan-on-demand approach addresses one of the biggest challenges to EMR adoption: maintaining the availability of patient information for practitioners during the record conversion process.

By Peter Ransome

Is it because the conversion of patient medical records seems like the "easiest" or the most tedious part of the EMR implementation process that decisions about it often get pushed aside until late in the decision-making process? This is all too often the case.

The initial question a medical practice has when planning an EMR implementation is "What is the most cost-effective and efficient way to convert thousands of patient charts to electronic records?" Depending on the practice, "active" records may go back two years or 10 years. A physician typically has an average of 1,500 to 2,000 active patient files, and retention periods for patient files, which are regulated by the states, range from seven to 20 years.

It is not uncommon for the medical practice to conclude that it can take care of medical records conversion internally. And because the practice is already committed to a significant investment in the EMR software itself, including training and implementation, there is often considerable pressure to shave costs wherever possible, and this often falls on the conversion of medical records.

While it is possible to do the conversion internally - by hiring temporary workers or repurposing existing employees - this is rarely a cost-effective solution. The least cost-effective option is to repurpose existing employees or hire new ones for the conversion project. Rarely does a medical practice have dozens of low-skilled, salaried employees available for this type of work, and hiring and providing benefits to new employees for a project that only takes months is not cost effective.

vYet hiring temps or college students brings its own set of issues involving accuracy and efficiency. Accuracy, consistency and speed are critical components to the medical records conversion process, and anything less than complete accuracy and the highest quality is not good enough. The work is repetitive and tedious, yet the job requires commitment and consistency.

Minimize disruption to the medical practice

A critical issue for medical practices is that medical records conversions are typically disruptive to practice management and patient care. It is understandably critical that all patient records and information be available at all times (and immediately accessible) during the entire conversion process.

In fact, this issue is often cited as an objection to converting patient records at all. Additionally, the issue gives rise to the belief that all records must be converted on premises. Fear of not being able to find a patient chart when needed, or having only incomplete information, haunts medical practitioners. The threat of malpractice lawsuits is never far away.

Hybrid solutions are not the answer

Yet, a hybrid solution that combines both paper and electronic medical records is not an optimal solution for a number of reasons. Some practices choose this route believing that they will save money. And while it is true that not converting 50 to 70 percent of (inactive) medical records saves the practice from that financial outlay, it proves to be a great risk that often leads to higher costs down the road for the following reasons:

  • Managing health information in a hybrid environment poses much greater risks to the completeness and accuracy of a patient's medical record, given the multiple media and access paths to that information. Simply, it is not possible to have all patient information "in one place" with multiple media.
  • Additionally, hybrid records are an expensive approach for healthcare providers because they do not realize the financial benefit of a fully electronic system nor do they fully realize the investment made in the software, implementation and training that supports EMR solutions.

The solution: Scan what you need only when you need it

We believe that the healthcare industry should look closely at the approach that many other industries - including finance, banking, insurance and the Fortune 100 - have used for more than a decade when it comes to storing and delivery of critical business information.

Convert only active patient records (files, office notes, lab results, etc.) and store inactive patient files off site in a fully secure, HIPAA-compliant facility that provides access to those records on demand or "on schedule" as needed via scan-on-demand services.

This approach to medical records conversion and records management takes into account the fact that up to 75 percent of medical records are inactive at any given time - depending on the medical specialty - and do not need to be converted to EMR.

Depending on the medical practice, active records typically range from one to three years, for example. A pediatrician's active records may only be a year, yet a cardiologist's may be five years.

The Information Lifecycle Approach takes into account the fact that up to 75 percent of medical records are inactive at any given time - depending on the medical specialty - and do not need to be converted to EMR.

Benefits of off-site storage and scan-on-demand

Complete records security and privacy

This storage-and-delivery model fully complies with strict federal, legal, HIPPA and privacy requirements. Records storage centers comply with rigorous NARA 36 CFR part 1228, subpart K standards related to facility security and fire safety.

Furthermore, professional records storage and processing centers incorporate the world's most advanced safety and security systems including in-rack sprinkler systems, firewalls throughout facilities and VESDA air-sampling systems.

Records storage facilities will have perimeter and internal office security 24/7/365. They will have access control features in place to limit facility access to authorized personnel and to safeguard all property on premises. Security features also include intrusion detection in the form of door alarms, infrared motion sensors and glass-break sensors. Surveillance cameras and motion sensors are located throughout facilities. In short, a medical practice's records are more secure at a professional records storage facility than they are stored on site at the medical practice.

24/7/365 immediate chart access

Patient medical charts will not be lost or go missing. They will be inventoried, indexed and archived as soon as they are taken off site using state-of-the-art scanners and bar-code technology. From that point, they are available 24/7/365 through a secure Web-based application via scan-on-demand services.

"Scanning on schedule" services are ideal for practices requiring that information be delivered "just in time" and prior to a patient's scheduled appointment. Patient records are scanned into the EMR platform for scheduled appointments.

"Scanning on demand" or "scanning on request" services provide electronic delivery of inactive patient charts to practitioners on request via a secure Web application.

This storage-and-delivery approach also addresses one of the biggest challenges to EMR adoption: maintaining the availability of patient information for practitioners during the record conversion process. Patient charts are accessible during the entire conversion process.

Lastly, moving files off site reduces administrative cost - which is a key cost in medical practices - and revenue-generating space is created in rooms where charts were previously stored. In short, file rooms can become exam rooms!


Medical practices will benefit from thinking out of the box when it comes to medical records conversion and using the same methods, processes and best practices that other industries have been using for more than a decade.

About the author

Peter Ransome is vice president, Healthcare Solutions, Diversified Information Technologies. He has worked with medical practices in medical records conversion, document imaging and document management for more than a decade. For more information on Diversified Information Technologies, click here.

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