Some 10 years ago, when I first started covering health IT, a lot of the talk was about the “modular” approach to EMR adoption, i.e., put in a piece at a time during a transition period. Much of that had to do with the state of technology at the tail end of the dot-com bubble, when companies developed applications to address one small problem, often in the hopes of getting a larger firm to shell out big bucks for their idea. (Wouldn’t you know, that’s how many vendors, most notably GE Healthcare, put together end-to-end enterprise systems.)
Implicit in any step-by-step transition to EMRs was the idea that there would be an interim period where providers would have to run dual electronic and paper systems. It’s a notion that’s always been with us, but how many people still think of it?
I got a reminder this afternoon when I spoke to Ken Rubin, Iron Mountain‘s senior VP and GM for healthcare, who was talking about results of a new survey on progress toward meaningful use. (I was ostensibly doing that interview for InformationWeek Healthcare, so look there tomorrow for coverage. Here, I just want to talk about one aspect of the conversation.) Rubin noted that there seems to be a sort of “no-man’s land” between the paper and digital. “I don’t see a real, well-defined way of dealing with the hybrid world,” when hospitals and medical systems are switching to EMRs while still retaining old paper records.
Obviously, Iron Mountain would like to sell some scanning, data management and shredding services to healthcare organizations, but Rubin has a point. The rules for meaningful use Stage 1 don’t say a thing about what you’re supposed to do with existing paper files, and it doesn’t appear that Stage 2 will address that issue either.
Do you scan all the old files immediately, or wait until each patient’s next visit, then chart electronically going forward? What do you do with the files of inactive patients? Do you archive records in house or offsite? Do you still need rows of files taking up valuable square footage that could be put to better use? What do you do with clerical staff? Do file clerks become managers of electronic health information, or do you need to replace those people with others trained in HIM?
Rubin noted that this limbo often works against organizations trying to overcome physician resistance to change. “The faster you can get to the other side, the faster you’ll get physician adoption,” he said.
That all makes good sense to me. CIOs and practice managers, what do you think? Have you addressed hybrid workflow during this transition period, or is the siren call of federal dollars for meaningful use too strong?