Some Other Ways to Change Your Medical Practice to Digital

Some time ago our practice was without enough office space for our patient charts. We thought about renting more space. I'd examined electronic medical record (EMR) systems for ophthalmology before, and it seemed like the time to go paper-less had arrived. Since then, we've been working on cutting our bonds to paper records.

A full conversion to an electronic medical records system will require a large investment of time and expense. Our practice, medium-sized with nine doctors and over a hundred staff at five locations, has the needed resources to realize this sort of goal. But what can a smaller practice do in order to take on such a large project?

EMR systems need input data. They then store the data electronically in a database. Then, this information can be used in an almost limitless way. The limits are actually defined only by the users' imagination and the software used. An EMR system with improved flexibility can intimidate the novice user, including most physicians. However, when a system has been set-up and custom modified, it can be extremely powerful. In fact, the extent of front-end customizations often correlate with back-end user rewards from using the system.

So, if a practice wants to bypass the up-front expense and effort to customize these EMR systems, what can they do?

Some medical practices have purchased EPM and EMR products but aren't using them to their full ability. Staff members make notes as they would normally, then scan them in the system. This is a 'scanning solution.' Many EPM systems have a module for scanning photos, paper records, or letters, regardless of whether they have EMR or not. The result is an electronic medical record or electronic health record, called EMR/EHR.

Because no data entry is required of the user, it isn't truly an EMR system. This type of system has the advantage in that practices use the existing EPM for processing paper documents without the cost of a new EMR system.

By shredding the documents after they are scanned, a practice eliminates the necessity for additional storage space. There's a disadvantage to this, however: because clinical data isn't entered into the system, it cannot be retrieved and used in a meaningful way. For example, the system wouldn't be able to follow trends in interocular pressure, or recall all the patients with the same diagnosis or prescribed medication. This type of information is quite valuable for pay-for-performance reviews and information auditing.

A stand-alone scan solution would be a less-expensive alternative: the solution offered by SRS Software (http://www.srssoft.com) is a good example. The solution can be a temporizing measure as a practice selects a total EMR system, or in the case of archiving a large volume of paper records. No data entry is needed here, as this is a digital version of handwritten documents. The benefits of using a scanning solution include the short learning curve, reduced cost, and the lack of the need for great change to normal operations. Compared to EMR systems, these scanning solutions have a higher implementation success rate.

Those practices that aren't ready to leave the comfort of paper record-keeping still have some options available for increasing efficiency and legibility of charts. Often, practices use notes hand-written on line sheets or blank paper. These are often written by the physicians. Unfortunately, these records are often misunderstood in information audits; the time savings from making quick notes can end up very costly in the case of an error. Instead, the use of several required field forms for the checking and circling of signs, symptoms and clinical findings is preferred. These ensure that billing and coding components are appropriately noted within the documentation.