Paper Chart Disposal After Implementing an EMR

I’d be planning on posting about this for a while and someone brought it up in the comments of one of my other posts. So I figure it must be time to talk about what to do with all those old paper charts. I’m not going to go into the specific regulations. First, I’m not a lawyer and don’t want to give any legal advice. Second, these regulations often vary from state to state and 50 is a lot of different regulations.

With that disclaimer, let’s take a look first at what to do with all the old paper charts that are no longer being accessed.

Archiving or Shredding Old Paper Charts
One of the big questions people ask is what do we do with the old paper charts. In this post I’m not going to talk about the various ways that you can incorporate your old paper charts into your EMR workflow. I’ve covered that a number of times before including my post about thinning your paper chart.

Instead let’s talk about what you do after you’ve had an EMR for a reasonable amount of time and you find that you’re no longer pulling paper charts on a regular basis. You might still pull the paper chart on some rare occasion, but for the most part the information you need is now in your EMR.

In my office, we chose to hire an outside company to take our paper charts and scan them into a little program for us. This did cost a bit, but it’s nice to have all of those old paper charts in a nice indexed format that we can quickly search and print out if someone requests their old records. You can even put it on a web server and do some partial integration with the program we store all these old scanned paper charts with our EMR. However, we haven’t needed to do that since medical records is the only one who ends up really accessing the charts.

Of course, the other option that I think many people do is just store them somewhere. This isn’t a horrible option since it can be in a part of your office that isn’t being utilized. It can even be off site if it’s cheaper to store it somewhere else. However, you just have to be careful of course that the location is still secured properly.

Are there other options available to those dealing with the old paper charts after implementing an EMR?

Tomorrow, I’ll follow up with a post on archiving your EMR records.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

13 Comments

  • >>”Are there other options available to those dealing with the old paper charts after implementing an EMR?”

    Outsourcing it is one way to go, but it does add up. Regardless of method, it really is important to handle the patient history in a way that gives you and the staff access to the complete history and the big picture for overall patient care. Now, it may vary to some degree depending on the specialty or type of practices, but over all it’s an important step in completing the transition to EMR.

    Completing the transition also apparently reduces liability and overall exposure. I recently saw an excerpt in a Harvard study that showed practices that continue to hang on to the physical paper are 75% more likely to have to settle a malpractice case.

    Capturing and converting all the patient history trapped on paper also accelerates your short-term first-year EMR return on investment because not only are you more efficient both inside and outside the practice, but you reclaim all of the dead chart storage space in the office so you can put it back to work and eliminate off-site storage retrieval fees and related costs.

    There’s some stories (videos) on our website that talk more about these real world scenarios.

  • Scott,
    Ok, interesting website. Tell us about your product. What’s the basic workflow for a doctor if they use your product to scan the paper charts? Also, how would they access the paper charts from their EMR?

  • The product was specifically developed to bridge the gap between paper charts and electronic records – helping a practice complete the transition to a “truly paperless” practice as quickly as possible – because that seemed to be a real missing link in the big picture when moving to EMR.

    You can see a live video of the actual scanning workflow at the following link: http://www.chartcapture.com/howitworks.html

    This little video is all of five minutes and really tells the story better than anything (…it’s the old “picture’s worth a thousand words situation)

    If you watch the video, you can see it’s pretty simple and self-contained – and really FAST. The practice can be up and running in a single afternoon (training takes all of 30 minutes) and they can put it in place months before go-live (or even while they’re still evaluating EMRs) so they’re all scanned up with active charts on day one of the EMR rollout.

    It also handles all the scanned file storage so the EMR database doesn’t get clogged up and overloaded, and it’s compatible with any EMR.

    We provide a free API to EMRs (that’s tech talk for “interface”) so they can drop a link into the EMR template and it automatically pulls up the scanned record – looking just like the paper chart, so you can keep mental track of what’s archive notes vs the new notes.

    A dear friend of mine is a physician and was explaining the challenge of what he and his partners (and the staff) were facing back in 2005. So, I investigated the available solutions for months and just didn’t see anything that made the process simple and easy to handle in the office with existing staff.

    I had founded and sold a software development company previously, so the combination of the clear need, the available experience and a desire to really make a difference for folks resulted in the ChartCapture product. It’s now in use nationwide and proving very helpful in the scenario you’ve described in your post.

  • I have also heard of smaller practices hiring an intern to do the document scanning. A much cheaper alternative to outsourcing.

  • Interns are a great way to go. Dollar for dollar high school help or college students on break (Summer and holidays, etc.) are a great source of help. I would also add that it’s ideal to pay per chart scanned ($0.X per chart), that way your interests are aligned around productivity and the ultimate outcome – and you minimize the risk of paying someone $10 an hour to listen to their iPod ; -)

  • Scott Ferguson,
    Thanks for the description. Sounds like an interesting solution that people should consider when looking at scanning charts. I appreciate you sharing another tool with us for solving this problem.

    Scott and Scott,
    Interns can be great because they’re cheap, but also have risks. The hard part with scanning is that rarely there is a way to verify that the scanning was done right. Which is the problem with scanning in general.

  • We have seen a similar need as you have Scott, and have create a family of products that can be deployed on an MFD, PC or network. Interestingly we created the Inofile product suite to work independently or to integrate directly to an EMR.

    Just in time scanning appears to be the trend and we are seeing fewer physicians send the documents to a service bureau in lieu of lower costs and discretionary scanning.

  • Dane,
    I know of very few clinics that are sending scanning out. The scanners you can get these days for your office are absolute workhorses and not too expensive.

  • when you are disposing of paper charts, do you need to check your EMR for a more recent chart, or is it sufficient to keep the paper chart only until the time limit for office visits in the paper form?
    [in other words, would the paper chart need to be kept until the patient has not been seen AT ALL for 6 consecutive years, or is it ok to dispose of it after the patient has not been seen for 6 years(or current legal time in the paper chart only?]

  • YWard,
    That’s an interesting question. I’ve never seen it play out and I imagine there’s no case law for it. Although, I should offer the disclaimer that I’m not a lawyer. Plus, this will likely vary from state to state. My guess is that the record is the record whether it’s on paper or electronic and so the record retention laws will apply to the whole record regardless of how it’s stored.

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