CNEA QUESTION 2: How have the clinics you support dealt with the hybrid environment of paper and electronic charts?

2. How have the clinics you support dealt with the hybrid environment of paper and electronic charts?


The Children's Clinic planned for dual paper and electronic charts prior to the go-live of the EPIC EHR system. Forms were developed to abstract paper charts prior to go-live. Charts of patients scheduled for the first two weeks of implementation were pulled, and providers were asked to abstract these charts during the administrative time prior to go-live. The abstraction process was used as a training tool. See below for a sample pediatric abstraction form:


Medical Records continue to pull papers charts and a new form was created for providers to mark paper charts for storage. Once charts are marked for storage and signed off by a provider, the paper chart was stored internally and not pulled again. The goal of The Children's Clinic is to shelve all paper chart by January 2011 (approximately 1 year after go-live). However, some smaller clinic have "boxed" all paper charts at this time. Below is our current work flow on paper charts answering questions A and B (will provide hard copy flow upon request).

THE CHILDREN'S CLINIC, Serving Children and Their Families
POLICIES AND PROCEDURES

SUBJECT: RETIRE ALL PAPER CHARTS
AUTHORITY: None

APPLIES TO: Front Office, Provider, All Staff
______________________________________________________________________

I. Purpose
To retire all paper charts from all The Children Clinic sites, leaving no paper charts on sites by the end of January 2011.

II. Policy
To establish a process that is provider driven for the approval of retiring a patient’s paper chart.

III. Definitions

1. Retired Chart: A chart that will no longer be pulled for patient care purposes and sent to storage.

IV. Procedure

1. Before the appointment, all paper charts will be pulled and designee will place a “Retired Label” on the upper right hand corner of the paper chart. The label will read as follows:

Paper chart retired from: Name of site (completed by designee)
Date retired: Date paper chart was retired (completed by provider)
Do not retire paper chart
Provider’s name: (completed by provider)
Provider’s signature: (completed by provider)
Date: (completed by provider)


a. The provider will sign the “Retired Label” and will fill in their name, signature if they approve the chart to be retired, and date.

b. At the end of the visit, the Medical Assistants will give the chart to the check out designee at the satellite clinics or the Care Coordinators at the S. Mark Taper Foundation Children’s Clinic Family Health Center. The designee will make a note under Permanent Comments in EPIC.

c. Standard language will be used as follows when making the note on the Permanent Comments section in EPIC:

Retired Chart by: Provider’s name and Date chart was retired

d. The Medical Records designee will then follow The Children’s Clinic current policy on sending charts to storage. Please note retrieval of chart can take up to 1 week from the day it was requested from storage.

2. If the provider does not want to discharge the chart, the provider can simply mark an “x” on the box that reads “Do not retire.” Then step 1b. will be followed.

3. If the patient is a “no show,” the chart should be given to provider, the provider will determine if patient’s chart should be retired.

4. For purposes of making future appointments, the front office designee making
appointments should:

a. Look at permanent comments to check if patient’s chart has been retired

b. If patient’s chart has been retired, then the front office designee making appointments should make a note on the appointment note section.

c. Standard language is used as follows:

Retired chart