Posted by: Kel Mohror
Decision Time, Part 1 mentioned developing a HIT strategic plan for your practice facility, in which you establish 1)what you want to do with HIT (achieve a stage of “meaningful use,” reduce ADEs, or other) and 2) how, in “broad brush-strokes,” you will reach that goal.
Decision Time, Part 2 will put on a spotlight on the “lifeblood” of your medical practice -- patient records. Converting (a.k.a. document imaging or document scanning) those shelves of manila folders of paper and multi-colored “stickies” in them to digital files obviously is essential to having a comprehensive EHR for all patents.
Nearly 2,000 50-page patient files can be stored as PDFs in a stamp-size 10 GB USB drive or memory chip. In the healthcare environment where interruptions and distractions are seemingly never-ending, these tiny storage devices are too-easily left somewhere, creating the potential for PHI breaches and fines.
Your strategic plan must address electronically storing your patient records, which begs the questions -- “How many?” and “How much is this going to cost?” Those numbers will enable you to weigh the ROI when estimating the cost of converting those shelves of paper when you start your EHR implementation. These numbers will also help when looking for scanning / imaging services that will index the records and create the electronic file structure per your specifications.
An index and structure enable quickly finding the correct record for your immediate use, unlike a web search that throws thousands or millions of “results” at you in a fraction of a second or an undifferentiated Windows® “Search.” (Finding a “needle in a haystack” might be a more rewarding task.)
You can roughly calculate the number of pages to be converted using a standard ream of paper and a measuring tape. Typically a ream of paper is 2 to 2 1/4” thick (use 2 1/8” for simplicity) and has 500 sheets of paper; these two metrics complete the calculation with a patient-record shelf length.
To save time, here are a few common shelf-lengths and the number of pages they support:
- A full 4-foot long shelf supports about 11,295 sheets of records and will use ~ 230 MB of memory.
- A full 5-foot long shelf supports about 14,118 sheets of records and will use ~ 287 MB of memory.
- A full 6-foot long shelf supports about 17,000 sheets of records and will use ~ 1 GB of memory.
For example, if you have 20 full 4-foot shelves, 225,900 pages of records have to be converted. (No, we can’t just sprinkle Holy Water on them and call it a day.)
At $0.08 per page -- depending on your negotiating skills -- to scan /image, index and correctly file the PDF, your cost is:
- For a 4-foot shelf ~ $903
- For a 5-foot shelf ~ $1129
- For a 6-foot shelf ~ $1360
Estimated migration cost for 20 4-foot shelves @ $903 is - $18,060.
Scanning your organization’s records (converting patient charts, administrative records, and x-ray films to electronic form) is a key part of implementing EHR. This task has to be high on your strategic “roadmap.”
“Document scanning is one method of many in a document conversion effort,” according to Vicki Wiler, Director of Publications at ARMA International, an 11,000-member association of professionals who manage records and information on a daily basis.
“Scanning and imaging replicate the appearance of paper documents; the resulting electronic files- usually a PDF- can contain textual and/or graphic information, including signatures, handwritten annotations, and illustrations.”
Thoughtful design of your file folder (directory) structure and creating a data index for each record, will make it easier to quickly retrieve the records of patients who had one on paper. Using the data index key words and phrases, you will optimize search results and save time because records can’t be misfiled nor left in an exam room. Document conversion also fills gaps in the medical record by merging multiple disparate records into an EHR.
It just so happens that the AHIMA has a document titled Practice Brief: Document Imaging as a Bridge to the EHR, which will provide additional “food for thought” and action.