Making Digital Patient Charts Work for Your Medical Practice

June 3, 2012
Carol Stryker

Electronic health records are great - if you maximize the positives and minimize the negatives of these digital files.

Too many medical practices experience serious problems with the retrieval of electronic documents that originated as paper. The root cause of the problems is a failure to adapt to the fundamental differences between paper and electronic charts in regard to filing/indexing and document retrieval.

Current processes work well for paper charts.

The primary objective with paper charts is to get the documents into the right chart quickly. Loose documents are likely to get lost. Carefully organizing a file to expedite subsequent retrieval is a secondary concern.

This order of priorities works because the search is manual. Nimble fingers can quickly scan through a large stack of paper and locate a specific document. Different sizes, weights, and colors of paper assist the search with visual cues. If a paper document is placed in the wrong chart, it is generally in a file close to the correct one. A search starts in the correct file and moves out from there until the document is located.

The process has a tendency to police itself because the people doing the filing often have to retrieve the documents later. Their self-interest motivates them to be reasonably careful in filing.

Digital filing systems are different.

The essential objective in a digital system is to associate each document with the correct index. If a document is not where it should be, it is hard to guess where it might be and an incorrectly indexed document may be lost forever.

Without appropriate organization, locating a digitally-imaged document can be more time consuming than retrieving a paper document. For the most part, the visual cues are gone. Searching for a specific page within a lengthy digital document becomes a mind-numbing, time-consuming series of clicks to view each page in order.

The priorities of the people doing the indexing are in direct opposition to those of the people retrieving the documents. The ideal situation for indexing employees is to minimize the amount of data they key and to store a complete chart as a single document. Those who retrieve the documents want to have more data in the index so that they have more ways to locate the right document. They want the documentation broken into small packets so that they can go directly to the pages of interest.

Digital imaging can be all pain and no gain.

Manual indexing takes more employee time than filing, and it is more error prone. More documents can be misfiled and become unavailable. Users have a hard time retrieving the specific pages they need. The records people are frequently called upon to mount a search for an original paper document. Everyone is skeptical of the system and refuses to let go of the paper documents, at least the archives.

Some simple techniques can produce digital charts that are a significant improvement over paper.

•Utilize tools that assist indexing.
Barcodes, OCR, and auto-indexing eliminate or minimize the need to key index data. Each of these three tools can be used to retrieve a complete document index constructed from information in a practice management system. They all make indexing personnel indifferent to the number of fields in the index and essentially eliminate indexing errors.

• Be generous in the number of fields included in an index.
Giving users multiple ways to locate a particular document mitigates the risk of losing a document. With tools that assist indexing, additional index fields add no overhead.

• Organize documents based upon the needs of the people retrieving them.
Employees preparing and indexing the documents handle the document once. The time they save by no longer having to retrieve and re-file documents more than compensates for any extra work in more specific indexing of documents - provided tools to assist indexing are in place. Separating the documents with target pages can provide visual cues during indexing and signal the start of a new document.

• Implement stringent quality control and backup procedures to make the documents reliably available and enable the confident destruction of paper documents.
The appropriate percentage of documents sampled for quality control depends upon management’s comfort with the accuracy of scanning and indexing.

NOTE: Consult legal counsel to identify those documents, if any, which must be retained in their original medium, even if they have been imaged.

Electronic health records can easily deliver on the promises of immediate and remote access, labor savings, and reduced space requirements. It requires implementation of tools and practices that maximize the positives and minimize the negatives of electronic documents.

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