Migrating paper to an EHR

May 4, 2007

Switching from paper charts to electronic health records is like any conversion experience-it takes a little faith.

Key Points

Switching from paper charts to electronic health records is like any conversion experience-it takes a little faith. However, patient data stored on a filing shelf doesn't miraculously move into a computer by itself. You've got to lend a hand.

The volume of data that you shepherd into EHR-land depends mostly on the nature of your practice and your personality. Specialists who typically see a patient just once or twice don't have to worry about a wholesale migration of data. Their primary care colleagues, however, need to access test results and medication lists found in the paper charts of thousands of ongoing patients. How much they transfer to the EHR is a matter of preference. Information pack rats may insist on keeping 20-year-old HbA1c numbers.

If you're going to install an EHR system, you have several conversion methods to choose from. All of them have been tested by other doctors who've gone down this road, so learn from their experience.

First, Muir's group automatically created the shell of a digital record for each patient when it imported demographic information from its practice management software. "Then we brought in three years' worth of transcribed dictation and filed it in a 'documents' section of each record," says Muir. "The dictation contained much of the information we needed to move forward." His group is slowly phasing out paper charts, beginning with ones for inactive patients. Those records are being scanned and burned onto CDs apart from the EHR.

Key in basic data. You can type the essential information found in a patient's paper chart-the problem list, the medication list, recent test results, the latest history and physical exam, etc.-into data fields of his individual electronic chart. Some doctors prefer to handle this clerical task themselves because they don't trust staffers to recreate the record accurately. If you do assign this job to a staffer, you're giving him or her a great EHR tutorial, says Rosemarie Nelson, a computer consultant in Syracuse, NY.

After you decide who's going to key in the data, you need to decide on when. One option-which could take several months-is converting all the charts before you begin using your EHR system. The other option is the gradual approach-entering data as charts are pulled for appointments. The same technique applies to scanning, which we'll discuss next.

Scan as you go. Having the ability to scan paper into your EHR is imperative. Otherwise, you'll drown in the hard copy that pours into your office from healthcare's technological backwaters. Accordingly, you need to invest in a scanner or two as well as the necessary software, unless your EHR program already comes with a scanning module.

Since you have this scanning technology in hand, the argument goes, why not use it to copy a patient's paper chart into the EHR when you book him for his next appointment? That's the advice given to doctors by Sam Bhat, vice president of sales for EHR vendor eClinicalWorks. This approach guarantees, says Bhat, that you'll convert charts for only those patients whom you'll see in the future-an important consideration for specialists whose patients tend to be one-episode affairs.

Bhat also recommends scanning just the guts of the paper chart-the medication and problem lists, the most recent progress notes and lab results, etc. Solo FP William Soper in Kansas City went that route when he implemented his EHR system in 2000. "We scanned maybe six to 10 pages per chart," says Soper. "It took a file clerk about two minutes to do it."

Once a patient schedules an appointment, Soper adds, a staffer can scan the record either before or after the visit. In the latter scenario, the physician uses the patient chart during the visit and designates pages that he wants imported into the EHR.