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Deciding to Go Paperless

Most medical offices today are using an electronic practice management (EPM) system. take-plunge.jpgThis software is a far cry from its paper-based ancestors, the appointment and ledger books. The EPM market has expanded over the last twenty or so years to include a variety of products on several platforms. And increasingly we are witnessing the digital revolution in electronic medical records (EMR). Unfortunately, while many such systems have been implemented, to this day a truly paperless office seems like a pipe-dream.

For subjective-objective-assessment-plan (SOAP)-based patient care, the first generation of electronic medical records (EMR) systems worked well. Medical specialties which are primarily text-oriented tended to fare better, as compared to graphic-oriented specialties such as ophthalmology. At our practice we have used an EPM since 1983. But although this software met our needs for billing and scheduling, we were still accumulating stacks of paper records which required an increasing expense just to store the paper.

As we considered a change to an electronic medical records system, our practice compared the expected costs for paper records storage to the costs of converting to a new system. We fully understood that we’d have to become more efficient to make the transition cost-effective.

System Implementation Costs include:

* Infrastructure
* Consulting
* Software
* Hardware
* Tech Support

We also included the cost of additional work-hours which will be spent training people on the new system, along with data entry. In most cases a practice uses both the old and new systems concurrently until the entire conversion is complete. In the meantime, there could be some redundant tasks.

The primary factor in our decision to switch to EMR was based on the need to reduce the growing mass of paper we were storing. And it didn’t hurt to hopefully ride the wave of financial incentives from the government for EMR implementation. Meanwhile, there was the opportunity to proactively implement new HIPAA privacy and security guidelines in a way that would work best in our practice.

System Benefits Include:

* Improved Communication
* Better Efficiency
* Improved Compliance
* Enhanced Documentation
* Justifiable Coding
* Improved Integration

At our practice, the business choice came down to the belief that we could recoup our investment in approximately five years. This calculation was based on the savings of projected storage space costs, along with reduced needs for printing expenses and services. The journal Health Affairs found that the average primary-care practice recovered its costs in 30 months.

It is more difficult to measure the value of change to job efficiency and changes in staffing patterns, but we are monitoring these factors to accurately measure returns on our investment. Some studies have shown reductions in medical records staffing of 0.25 – 0.5 full-time equivalents (FTEs) as well as significant savings in dictation costs.

The overall trend seems to be toward a world where EMR is the norm. Insurance companies and government are placing more pressure on health-care providers to standardize medical records, and EMR could soon become obligatory. Costs are dropping as more businesses adopt the technology; soon even the smallest practices may find it cost-effective to ‘go paperless’.

3 Comments

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  1. We have a SaaS “Software as a Service” web application which facilitates paper to digital conversion of data by simply scanning all paper forms through a standard scanner. Our software extracts and processes the data from the paper forms then process the data for updating patient records and billing without data entry. Claim Link organizes the document images, audits for missing documents and makes them searchable by several criteria. Practitoners can store all their paper including EOB’s, personal tax forms, anything. We also allow video, graphic and audio files to be filed away along with the document images. The system uses a new form of artificial intelligence to read Practitioners’ hand written notes, learning each “author’s” unique handwriting styles as a result of processing the information. Claim Link makes it easy to use paper as a medium for easily recording information, then eliminating the “paper shuffling”.

  2. Wonderful topic and nice to see real world examples. I am all for going paperless.

    My question is about the integrity of the electronic data that is being stored (also known as Electronically Stored Information or ESI)?

    I feel that this is often a very important matter that is overlooked when going paperless. To quote former HHS Secretary Mike Leavitt,
    “Data Integrity – Those who hold records must take reasonable steps to ensure that information is accurate and up-to-date and has not been altered or destroyed in an unauthorized manner. This principle is tightly linked to the correction principle. A process must exist in which, if consumers perceive a part of their record is inaccurate, they can notify their provider. Of course the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers that right, but this principle should be applied even where the information is not covered by the Rule.”
    (http://www.hhs.gov/news/press/2008pres/12/20081215a.html)

    After you get rid of all the old paper after the records have been converted to digital, or even if they are are already in a digital format, how can you ensure the authenticity of the record? Can you use that information in court? A small case in Maryland (Lorrain v Markel American Insurance) may shed some light on the future of using electronic data in court. The judge on the case would not allow the digital data to be used, even after both sides agreed, because the authenicity could not be proved like paper records. In his remarks about the case, Judge Paul Grimm states, “… if it is critical to the success of your case to admit into evidence computer stored records, it would be prudent to plan to authenticate the record by the most rigorous standard that may be applied.”
    (http://www.mdd.uscourts.gov/Opinions/Opinions/Lorraine%20v.%20Markel%20-%20ESIADMISSIBILITY%20OPINION.pdf)

    Also, what about the integrity of the data if it leaves your nice, safe and secure EHR? All EHR’s are system centric, which means that as long as the information resides in the EHR it is protected. People need to be aware of making the records file centric, so no matter where it goes or resides, the integrity is secure and the authenticity can be checked at anytime.

    When going paperless please keep that in mind. The reason I know so much about this subject is because the company that I work for makes a product called TruSeal. TruSeal is a simple, convenient, and cost effective way to safeguard the evidential strength and integrity of digital data. To achieve this TruSeal can works with the EHR, securing the who, what and when of any file type. Please check out our website for more info.
    http://www.TruDataIntegrity.com
    Please comment I’d like know if you’ve thought of this as well.

    • Eric, thanks for the info. Most of the more-established EMR software vendors are aware of these issues and try to stay on top of the (ever-changing) legal aspects of electronic medical records. We will be releasing some practice management resources which include interviews with experts in various fields related to EMR – one of them is an expert on E-Discovery and legal issues of EMR. For those of you who still have questions: stay tuned – you might find it quite applicable. Thanks for the comment.

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