Meaningful Use Question 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?

Currently, the plan is to retire charts according to naturally attrition. One of the reasons for that is to save man hours on processing records into EMR of patients which may not be seen here again. The logical choice would be to phase these paper records out through regular retention guidelines (7 years or for Pediatrics 19 years). We have made some exceptions to that rule. For instance, when a duplicate record is found and has to be combined, we are processing both records anyway going through all documents. Under these circumstances, the records have both been processed so they get scanned and indexed into the EMR so the combined record is EMR only and the paper can be shredded.

One technique for reducing the amount of records on the shelf was if there was a small record with just a few pieces of paper, rather than pulling it over and over, the record was incorporated into the EMR.

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?)

It took about 7 months for the majority of the physicians to be comfortable with their records being solely in EMR. Records were still pulled during this time to be checked to see if they were entered into EMR correctly and to have available in case the physicians wanted them (per their request). There were quite a few shifts in thought along the way, (i.e. categories, document types, where staff thought things should go, etc.). Currently, we pull about 10-15 charts for roughly 400-420 patients in a day [Main Clinic]. Provider preference seems to be the driving factor in this.

c. What sort of chart audits or usage audits are conducted on a routine basis to assure that organizational standards are being adhered to?

Scanning productivity

Indexing productivity

Refile productivity

Errors rates:

Wrong category

Wrong document type

Poor quality scan

Wrong chart

Duplicates

Pages not filed within 24 hours of receipt

E/M Coding

ICD-9 accuracy

Record content