MEDICAL RECORDS SCANNING FAQ’S
My practice is moving to an EMR, what do I do with all the patient records in our chart room?
You will need to choose between one (or a combination of several) of the following options:
1. Continue to store them in your existing on-site chart room
2. Scan them and attach them to the electronic patient record in the new EMR
3. Scan them and store the images in a repository that is separate from the EMR
4. Store them off-site at a business records storage facility
5. Store them off-site in self storage space
Why should I scan my old charts?
The main reason to scan your charts is to improve patient care and reduce liability by making them easily accessible to your physicians and staff.
If you don’t scan your charts, you’ll be forced to manage two systems – one that is electronic and one that is paper based – a “hybrid” system. Managing both systems can be frustrating, inefficient, and potentially result in poor patient care. A hybrid system usually results in slower adoption of the EMR and it’s not uncommon to see physicians in an exam room with a tablet PC and the paper chart.
When you receive release of information requests you can provide the information faster, cheaper, and more securely than retrieving and copying or scanning paper files and mailing or faxing them. You can also turn the release of information request into a revenue generating opportunity.
You’ll have a large portion of your office space consumed by files and all of the labor costs associated with managing those files. Wouldn’t it be better to convert that space into another exam room or use it for some other revenue generating activity?
Off-site storage may appear to be inexpensive, but if you have to keep your records for an extended period of time (pediatrics, women’s health, urology, etc.) storage charges can greatly exceed the cost of scanning charts, especially if there is a high level of retrieval of charts from off-site storage. Storing charts in a self-storage unit could be a potential HIPAA violation. Self-storage units are often targeted by thieves, putting patient information at risk.
Once my charts are scanned, do I need to keep the paper chart?
In most instances, you can destroy the paper as long as you have scanned the entire chart. We advise that you consult a trained legal professional to ensure compliance with all laws and regulations pertaining to your specific practice.
Do I need to scan the entire chart?
Some practices choose to scan only certain sections, but you may be forced to keep the paper if you don’t scan the entire chart. You may be faced with maintaining two separate systems, one paper based and one electronic. How will you know what information is in which system? How much will it cost to continue to staff the chart room with medical records staff? If you eliminated the storage space, could you add another provider(s) or diagnostic equipment and generate more revenue? These are all questions to ask yourself when making this decision.
Another important thing to take into consideration is potential future litigation. You could find yourself in a situation where you have conflicting information in the paper chart that wasn’t brought into the electronic medical record that could be damaging in the event of a malpractice or other suit. You need to make sure you keep information for the required amount of time and if your records aren’t integrated you could potentially miss information that could affect patient care. It is also not uncommon for us to find multiple charts for the same patient when we do a conversion. Scanning all the charts is an opportunity to clean up your existing patient information.
Do I need to scan all my existing charts?
Different practices have different needs. In many cases, we recommend that only charts for patients that have visited in the last 12-18 months be scanned. In some specialty practices like Pediatrics, charts may need to be kept for up to 28 years. The cost of storage for that length of time will exceed the cost of scanning the charts. Our consultative process includes an assessment of which charts should be scanned and which might be better serviced by a secure document storage company.
If you have older charts and the patient hasn’t visited in a long time, those charts may not be worth scanning. You’ll want to make sure you have a mechanism in place for destroying old charts once they meet their retention requirements. Keeping the paper chart exposes you to liability in the event of litigation if you have kept records that could have been destroyed once they met their legally mandated retention requirement. All records that you have, whether they are paper or electronic, are discoverable in the event of a lawsuit. It can be challenging to manage records retention if you have more than one repository.
Why don’t we just hire some temps to scan our charts?
Practices tend to look at three things when they make this decision. The cost of a scanner, it’s rated throughput, and the “low cost” of temporary (or family member) labor. The labor costs of prepping the charts (taking out paper clips, staples, etc.), indexing the charts, and quality control are often not factored into cost estimates for in-house scanning. These items combined typically cost 2-4 times as much as the actual scanning.
Perhaps you already have a scanner or a digital copier that can scan. A service bureau will use equipment that can capture 4 or 5 times as many pages per minute as most copiers or office scanners, greatly reducing the labor cost per image. If you use a digital copier, you will have people “fighting” over the resource and the person doing the scanning will be frequently interrupted, decreasing efficiency and increasing the chance of mistakes.
Typically, the same person doing the scanning is also removing paper clips, staples, etc. to get the charts ready for scanning and then indexing the charts after they have been scanned. The net result is that the scanner is often sitting idle and the actual throughput is about 20-30 percent of the scanner’s rated speed. The project you thought would take 4 or 5 months ends up taking two years!
Since the same person is often doing all the work, the chance for mistakes increases exponentially. A service bureau has different personnel working on each step of a tightly controlled and carefully designed custom workflow process so that work is always being cross checked. A quality service bureau will also have an independent quality control step built into their workflow to ensure all pages were scanned and legible.
A service bureau will have a team dedicated to your project allowing it to be completed in weeks, instead of months or years.
An experienced service bureau utilizes high end production scanners, state of the art workflow management tools, and has developed processes over the years that result in a highly efficient quality driven process. While scanning seems relatively simple, there is a big learning curve and it just doesn’t make sense to try to re-invent the wheel.
We have had to re-scan entire chart rooms for practices that didn’t have a good quality control process. Patient information was indexed incorrectly, inter-mixed in other patient charts, and illegible. We’ve also had practices that did their own chart scanning tell us that their project took months longer than anticipated and ended up costing 2 or 3 times as much as we quoted.
We utilize advanced technology that allows us to automatically separate the charts using the same tab methodology you use in your paper charts and we utilize existing patient demographic info to automate the indexing process, provide more search information, and improve accuracy. Charts scanned by an experienced service bureau will be easier to use, accurate, and all images will be legible.
Temporary employees are often overlooked when it comes to confidentiality and HIPAA training.
What about patient confidentiality?
We ensure HIPAA compliance through a combination of personal accountability and physical security. All employees must undergo criminal and credit background checks prior to employment and execute confidentiality agreements as a condition of employment. We provide ongoing HIPAA training. We utilize an independent auditor that performs an annual HIPAA compliance review. We execute Business Associate agreements with all customers and carry a high amount of liability insurance. Our scanning facilities are secure locations that are locked 24/7 and under 24/7 internal video surveillance. All employee work activity is tracked to the file level for every project.
What if we need a chart while you’re working on it?
We utilize a secure e-mail solution that allows us to e-mail a scanned chart to you if you need it while we have it at our scanning center. We can also provide encrypted FTP access and in some cases we can send it directly to your EMR. We work with clients to schedule the project so that only a small portion of your charts are in our facility at any one time.
Do we have to scan them all at once?
Some practices prefer to spread out the scanning expense and we will work with you if you need to spread your budget over a period of time. Some practices send us their charts once a week after patients have visited. Others send us charts for the patients they have scheduled for the upcoming week so that they are available in the EMR when the patient visits. Both of these options ensure that you’re only scanning charts for active patients. We’ve also had practices that send a pre-determined number of boxes each week to spread out the investment.
When preparing for an EMR migration, many practices perform a pack and purge each year. Instead of sending the oldest year of Medical Records to an offsite storage facility the records are scanned and held in an online archive until the go live date for the EMR implementation.
Can you scan into our EMR system?
We have performed dozens of conversions into a multitude of EMR systems. To date, we haven’t found any that we haven’t been able to scan into and we currently have templates built for most of the major EMR systems.
Do you offer other solutions for medical practices?
We are constantly looking for other ways to add value to our relationship with the medical practices we serve. We have developed cost saving solutions that automate revenue management, release of information, and other time consuming manual processes. We provide solutions that eliminate labor and manual data entry including conversion of paper EOB forms into a Medicare compliant 835 EFT file. We also provide an audit solution for comparing the maximum reimbursable amount in your contracts against actual reimbursements.
Do you work directly with EMR providers?
A number of EMR providers recommend our services to their customers because they know we do quality work and have the technical expertise to format the scanned charts correctly to make them available in their EMR. We actively partner with the EMR providers and understand how their solutions work.
What else should I take into consideration?
Clients often wrestle with the issue of whether to scan the entire chart or not. If you think you don’t need to scan the entire chart, ask yourself a few questions. Will the time spent weeding out pages end up costing the same or more than simply scanning those pages? Am I putting patient care at risk by not having all the pertinent information I need? Am I exposing myself to liability by keeping records that could be purged? What will my storage costs be? Can I put the space occupied with charts to other use as an exam room or the home of a new piece of diagnostic equipment that will generate revenue?