CNEA Report Question 2

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

a. What is your plan for chart retirement?

As previously mentioned in question 1 we have a clinic that was put in a unique situation for managing the paper vs. EHR hybrid environment. Our plans for handling the overall process were as follows:

· Front office staff abstracted all electronic visits for family history prior to the scheduled appointment.
· Front office tagged the paper chart with a colored label and date of visit to designate an electronic vs. paper visit.
· Front office scanned in the PCC and notes for all paper visits into the EHR.
· Providers printed the Master IM document for all electronic visits so that the front office could add it to the paper chart.
· Because of a lack of personnel at the clinic we began to send charts to our admin office. From here a nurse would abstract the charts to the EHR. The patients chosen had appointments one to two weeks out. Beyond that our diabetic coordinator began working on abstracting all diabetic patients. Once the nurses were done abstracting the chart and signing off, the provider would then review any notes and sign off as well.

Our plan for retiring charts is probably fairly long term as we still have providers partially on paper. We also have a large amount of abstracting to do. Once this is done a chart can be retired based on the recommendation of the provider. If an adequate amount of abstraction and visits have been completed electronically, at this point the chart would be tagged for follow up and review by the provider and upon approval would be retired.

This process is partially dependent on the providers themselves as some are more reluctant to manage their visits without browsing the paper chart.

b. In general, how long does it take before the chart is no longer pulled routinely for the visit? What circumstances cause this to vary (patient type, provider preferences, etc)?

Our goal is to begin at least “thinning” the paper charts (after scanning and or abstraction) and to retire the charts either after a certain amount of visits for “frequent flyers” or based on a proper amount of abstracting and or scanning.