Not Ready for an EHR? Try an EDMS

August 25, 2010

Even if you choose not to implement a full EHR right now, you can take a big step toward digitizing your practice.

It is well understood that implementing an electronic health record is not a walk in the park. Is there an easier way to digitize your practice?

Well, not really - but there is a transitional approach that can start you on the road to a more digital future.

It’s called an electronic document management system (EDMS). An EDMS allows you to digitize paper patient records so that they can be viewed and stored on the computer.

Here’s how it works: paper documents are placed onto a scanner, which takes digital pictures of the documents. The pictures are then viewable using a software program that allows a person to index or file the scanned documents for particular patient. The paper documents are then shredded.

At its simplest level, an EDMS can consist of $150 scanner, a PC, and a staff person that scans and files the digitized documents. However, this relatively low-tech system quickly becomes impractical when you start trying to scan high volumes of paper.

For this you need a high-speed, self-feeding scanner. Self feeding means that you can put a stack of paper on the scanner and walk away - very important in terms of productivity. Speed is measured in pages per minute and ranges from a poky 15 pages per minute to a zippy 160.

Scanner prices follow speed, with lower page per minute scanners starting at under $500 and ultra-fast models listing at over $10,000. According to one friend in the EDMS business, a 25 to 50 pages-per-minute system in the $1,000 range would be adequate for most small practices.

The indexing software adds another layer of sophistication. As you recall, this is the software that allows you to electronically file your scanned documents. Practices can either scan the documents in a general electronic folder under the patient’s name or create a virtual chart with all the relevant sections found in your paper document, such as lab reports, progress notes, and medication lists.

The indexing software helps you create the various sections of your virtual chart and makes it easier to file scanned documents by allowing you to link a document type, such as progress notes, to a specific section of the virtual chart.

If your practice uses standard forms as a routine part of daily work flow, your EDMS vendor may be able to recreate these and add a nifty bar code that identifies the type of form and where it should be filed in the patient’s chart. This helps save a lot of time in the electronic filing process.

However, while the indexing software is sophisticated, it is not entirely automated. A standard part of the indexing process requires a staff person to manage the flow of the scanned documents into the virtual charts.

Using these tools, you can build a pretty sophisticated electronically stored chart, while your clinicians continue to use paper as the primary means of collecting and recording information. It gives you the advantage of improved access to documents, since anything stored via the EDMS is available to anybody with a computer that has access to the system - a much more efficient alternative to relying on the medical records department to retrieve paper-based records.

Not quite an EHR

So why is this not a perfectly acceptable electronic health record?

There are a number of reasons. First, scanned data is essentially locked within the scanned document and is not available for reporting, preventive reminders, or decision support. In contrast, much of the data in EHRs, such as lab values, vital signs, and medications, are stored in a searchable database.

Part of the government’s big push for EHRs is to initiate quality reporting, particularly on chronic diseases such as diabetes, asthma, or heart disease. While you can retrieve this information from scanned documents, it is a labor intensive, manual process that will not be practical for busy practices. Reports are much easier with EHRs.

Additionally, scanned documents are passive. They are simply waiting to be viewed. Conversely, data in EHRs is dynamic - which is very helpful as you are seeing patients. Here’s an example: A diabetic patient shows up with a complaint unrelated to his diabetes, but is overdue for a number of preventive care measures. The EHR triangulates patient, problem, and overdue preventive care data and prompts you (or your staff) to include the overdue tests as part of the visit.

The dynamic, automated capability of EHRs makes them very powerful tools for pulling together the right information at the right time in the service of patient care. This is one of the reasons that the government incentives require providers to use EHRs - they have a much greater capacity to positively impact patient care.

Where does the EDMS fit in? For the average practice that is on the pathway to an EHR over the next 24 months, an EDMS can give you a taste of the move to the digital world without the cost or work flow disruptions of a full-blown EHR. Additionally, it can give you a head start on moving some of your patient information to a digital format.

If you are considering this path, make sure that your EDMS can be readily linked to an EHR. This anticipates that you ultimately will be using the EHR as the primary data repository and the EDMS for historical documents. You should be able to hyperlink from a patient’s chart in the EHR to the information in their EDMS without having to open a new application and do a new search for the patient.

There is also the important question of what to scan for the pre-EHR practice that wants to get a started. An ambitious and not very practical approach is to scan the entire chart for all of your active patients. While you will have created a virtual copy of the entire chart, the time and expense of the effort is probably not worth the benefit. There is a tremendous amount of paper that gets stuffed into a chart that has limited value.

A better approach is to selectively choose documents that might want quick access to when you make the full transition to an EHR. Additionally, in the long run, you will probably want an EDMS that is integrated with the EHR, so that scanned documents are “filed” within the EHR and not in a separate virtual chart.

With this last point in mind, for practices that are within 12 months of pulling the EHR trigger, it probably makes the most sense to select your EHR first and add an EDMS that you know will be good fit with your selected vendor. Robust EHR and EDMS compatibility is well worth a few extra days of using of paper.

Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. He can be reached via

This article originally appeared in the September 2010 issue of Physicians Practice.