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Conversion from paper to electronic medical records work breakdown structure

A myriad of challenging and complex decisions must be made, ranging from selection and implementation to training and maintenance.

Failure to adequately evaluate the clinical workflows and information needs associated with providing care and a lack of planning during and after go-live will result in a fall back to paper, thereby jeopardizing the success of the EHR adoption. This practice brief outlines the considerations and decisions that must be made for an effective migration from paper to EHRs within a physician practice or clinic.

It also provides recommendations about what to do with historical patient information contained in the paper records that exist at the time of the changeover. Decisions, Decisions Physician practices and clinics must consider the following questions when transitioning to EHRs: Which historical patient information should be available for patient visits during and after the transition?

What are the best methods of converting this information to the EHR? What is the best way to ensure that the converted data and information is of sufficient quality? How long should the paper record be available after the conversion?

Migrating from Paper to EHRs in Physician Practices - Retired

How long do paper records need to be kept after the transition to the EHR? What is the role of printing and should it be allowed during the transition?

There are no one-size-fits-all answers to these questions. However, they must be considered and will largely be driven by two factors: The Needs of the Practice Clearly the type of patients seen in the practice will dictate what and how much historical patient information should be converted in preparation for EHR implementation.

Primary care and certain medical specialties such as cardiology generally need more historical information, which requires more types of information such as past diagnoses, diagnostic test results, medications, and significant past medical history.

Other specialties whose services are more episodic or consultative, such as orthopedics, may have less need for historical patient information. A multispecialty practice with these specialties will have to obtain consensus from all stakeholders as to how much patient history to include within its EHR. For instance, will the records of all active patients who were seen recently be converted, or will the conversion be undertaken only upon scheduling of a new appointment or service?

Deceased patient records must be stored for the appropriate retention period and should not be scanned into the system. This will allow for all resources to be effectively used to convert current patients. Use of Paper Records In planning its transition to the EHR, a practice must determine how paper records will be used during and after the changeover, including printing permissions and restrictions. In the absence of clear guidelines, either activity can easily grow out of control.

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Circulating Paper Records Practices must determine which patient records to convert to effectively make the transition. The appointment schedule can be used as a guide to ensure all patients scheduled have their records converted.

Once a paper record has been converted, staff should use the paper version only as a reference. Practices should clearly document and communicate these expectations to staff. Practices can use reminders and notices on converted paper records to ensure that providers do not add new patient information to these records. Factors Affecting the Use of Paper Records Many factors can affect how long a practice uses paper records. The longer a practice uses paper records, the more it will hinder the success of the conversion.

In order to gauge how long and to what extent paper records will be used, practices should examine the method of the rollout during the planning phase of the conversion. There are two types of rollouts: In a big bang rollout the whole practice converts to the EHR at the same time.

Conversion from paper to electronic medical records work breakdown structure

In a staged rollout, the conversion occurs in phases, usually by specialty in multidisciplinary practices or by location in larger practices. For either method, practices should consider the following: How to effectively train staff Modifying staffing schedules during the transition Expanding or spacing patient schedules during the transition How issue resolution will affect the entire practice The amount of time for full implementation to bring the entire practice online The complexity of the patient The amount of historical information converted Records that have not yet been converted In addition, practices that choose a staged rollout must consider how to handle those divisions still using paper to ensure patient safety is not compromised.

There are no specified timeframes designated for when a practice should stop circulating the paper record. However, the longer the record is in circulation, the higher the risk to the practice.

The period of time depends on several variables including the rollout schedule, effectiveness of training, and the trust and confidence of the quality of the converted data. Practices must develop policies and guidelines outlining printing privileges and should not permit any writing or recording of patient information on printed records from the EHR.

Practices must implement and enforce processes for direct entry to eliminate the need for printing records when the patient is seen.

The criteria and permissions that allow printing from the EHR and the precautions and actions that must be taken with printed information, including destruction, must also be clearly documented within policies and procedures. Other added measures that can be taken to help limit the desire to print conversion from paper to electronic medical records work breakdown structure reducing the number of printers and placing colored paper in printers to identify records that have been printed.

Regardless of the methods used, effective planning, training, and communication are crucial steps to minimize printing during and after the conversion. Key Participants The conversion team should include representatives from each discipline of the practice. Clinicians such as physicians, physician assistants, nurses, and other care extenders can provide insight on document and data needs for patient care.

These individuals can help select the data for conversion, ensuring the transition is a success. The practice manager will take an active role on the team. The manager understands the business uses of the data in the record and can identify elements such as demographics, advanced directives, and information used for billing and coding.

  • Which historical patient information should be available for patient visits during and after the transition?
  • Staff members in decentralized locations are not typically dedicated to scanning, so this is usually the last task to be completed and thus often not accomplished daily.

The document management and conversion process requires knowledge in data management, data integrity, and compliance and legality of the health record. Optimally an HIM professional would supply this knowledge.

The IT department or staff also needs to be involved. IT must understand the needs of the practice in order to set up the system to properly convert the data to accommodate the practice. IT must also understand the elements to be captured when setting up templates, drop-down boxes, or other areas that require structured data entry. As key participants identify information for the conversion from other systems, IT will be able to assist in determining cost and feasibility for the request.

This multidisciplinary team will ultimately guide the organization in the decision-making process on the method or methods for the conversion process. Methods for Converting Data There are multiple methods to consider when converting data. Existing systems and availability of interfaces are decision drivers. These systems may have historical information that help populate the EHR, and direct interfaces may allow for ease of retrievability.

Direct data entry and scanning are other options to consider. Whichever method the practice decides, consideration must be given to both cost and patient safety implications. Back scanning drug allergies must be avoided because it cannot be cross referenced and may put patients at risk. Choosing the appropriate data conversion method also depends on the resources available to the practice for the conversion, the timeframe for the conversion, and the amount of information to be converted.

Required elements of the meaningful use incentive program also must be taken into consideration as the practice transitions to an EHR. There are tradeoffs to be considered such as cost of direct data entry, scanning, or custom interfaces. The need for paper reports will quickly diminish as notes are integrated into the EHR.

Consideration should also be given to other ancillary systems such as lab and radiology.

  1. Existing systems and availability of interfaces are decision drivers.
  2. These systems may have historical information that help populate the EHR, and direct interfaces may allow for ease of retrievability. Whether practices choose to employ centralized or decentralized scanning, they must ensure they have the right policies and procedures in place to validate data quality e.
  3. There are no one-size-fits-all answers to these questions.

To identify what to electronically back load, the practice should determine: The patient population Where interfaces can be created or data downloads can be performed Whether the final version of the patient information is stored in the electronic system Electronic historical information including all patient records, clinic notes, labs, and radiology Document Imaging Document imaging is a very resource-intensive process that entails indexing for retrievability and quality.

Practices must carefully consider how much patient information will be scanned during the conversion process. Scanning too much information will impede the provider workflow. Providers will not be able to easily locate pertinent information on the patient with multiple pages and entries to review. Document imaging may be done centrally, decentrally, or in combination depending on workflow, process, and practice needs.

Centralized document imaging requires that all documents within the organization be sent to a central location for scanning and indexing into the imaging system. Based on organizational need, documents may be delivered internally or via courier multiple times throughout the day to the central location. Decentralized document imaging is the process of scanning and indexing at each individual location. Scanning workstations can be placed in various locations throughout a practice or clinic such as in registration areas or other off-site locations.

Scanning and indexing can be done immediately or documents can be placed conversion from paper to electronic medical records work breakdown structure a queue to be indexed at a later time. Decentralized scanning may allow documents to be captured more quickly, allowing for a quicker EHR conversion. However, there are some risks associated with decentralized scanning. For instance, timely scanning may become an issue.

Staff members in decentralized locations are not typically dedicated to scanning, so this is usually the last task to be completed and thus often not accomplished daily. Another risk occurs when the decentralized staff must index the documents. The consistency of the filing can be compromised because decisions about how to file documents often differ from site to site, even though policies and procedures are clearly outlined.

Whether practices choose to employ centralized or decentralized scanning, they must ensure they have the right policies and procedures in place to validate data quality e. Centralized scanning is recommended for ensuring standardization and consistency in retrievability of patient information. The best quality and turnaround time are usually achieved when staff are dedicated to the document imaging process.

Conversion Resources Depending on the size and needs of the practice, the budget and staffing required for the conversion could range from very little to a factor approaching that of the EHR implementation itself.

Conversion is generally accomplished using one or more of the following: Manual data abstraction from paper records Computer data interfaces between existing systems such as practice management software Document imaging of paper records These methods are all labor intensive and require solid data validation and other quality control mechanisms. Practices should limit the amount and type of data converted from existing paper records in order to make optimal use of their resources.

It will ultimately be up to the clinicians to make these decisions. However, common data and information types that are minimally considered for conversion to the EHR include: Key patient demographic data.