the path to paperless
For now, a scanning
system may be adequate.
By Peter J. Polack, M.D., F.A.C.S.
In a multipart series, Dr. Polack is describing
how a seven-partner practice, Ocala Eye in Ocala, Fla., with five locations and
140 employees, makes the major transition from paper medical records to EMR. During
the course of the series, Dr. Polack will provide readers with a "real-time" look
at how the implementation is progressing. This is part 17 of the series.
of years back, we were facing a lack of physical space for our patient charts and
were even considering acquiring additional office space to store the flood of paper
records that was threatening to inundate our practice.
had been looking at EMR systems tailored to ophthalmology for several years and
definitely felt that the time had come for us to go paperless. Since selecting an
EMR system and developing a well thought-out implementation plan, we have been working
on our eventual severing of the umbilical of paper records.
It has been a long haul of planning, training and implementing
parts of the network a little at a time, but our practice will soon "go live" with
our complete EMR system.
However, we know that Ocala Eye is not typical of every practice.
In this article, I will discuss some possible alternatives for practices that either
do not have the desire to or do not have the resources to convert
to an EMR system at this time.
EMR is Not for Every Practice
Conversion to a full EMR system requires a considerable investment
of time and money. As a moderate-sized practice with nine physicians and more than
100 employees that are dispersed across five locations, we have the necessary resources
and staff to accomplish this goal. But what about a smaller practice, or one that
is not ready to commit to such a considerable project?
A true EMR system requires input of data and stores it digitally
into a database record. These data can then be manipulated in an almost limitless
fashion – limited in most systems by the software and in others by the imagination
of the user. The increased flexibility of some of these EMR systems can also make
them more intimidating to the novice (as most physicians are). But once it has been
set up and tweaked, an EMR system can be very powerful. Thus, the more extensive
requirements on the front end reward the user on the back end.
Are There Alternatives?
What, then, are some alternatives to a fully digital EMR system
for a practice that wishes to forgo the effort and expense (at least up front) that
these systems necessitate?
Some practices have bought what is essentially an electronic practice
management (EPM)/EMR product but are still not using the EMR system to its full
capability. For example, notes are handwritten as usual and then they are scanned
into the system. This is known as a scanning solution.
Many EPM systems with or without EMR have a module
for scanning in paper records, letters or other items such as photographic prints.
The result is what is known as an electronic medical record or health record. But
since there is no actual data entry on the part of the user, it is not a true EMR
system. The advantage of this method is that a practice can use an existing EPM
system to handle the volume of paper records without the added expense of an EMR
has Limited Uses
The practice can create a policy for shredding of documents as
they are scanned, thereby freeing office space for other uses. The disadvantage
is that because clinical data are not entered into the system, data cannot be retrieved
for any meaningful manipulation.
Examples of the drawbacks of scanning would include being unable
to follow a trend in glaucoma patients' IOPs over time or being able to pull up
all patients with a certain diagnosis who are on a specific medication. This information
may be invaluable for information auditing used for such emerging concepts as pay-for-performance
It is almost certain that practices will need to have a fully
functioning EMR system in order to meet the reporting requirements of P4P, which
could become a reality in the next several years. Practices that cannot furnish
the information required by a P4P system run the real risk of being reimbursed at
lower rates than those practices that can clearly demonstrate efficient operation
and a record of favorable patient outcomes.
One less expensive alternative to EMR is a stand-alone scanning
solution such as the one from SRS Software (www.srssoft.com ). This system can
even be used by those few practices that do not have a full EPM system. It can also
be used as a temporizing measure until such time as a practice decides to use a
full EMR system.
It is also useful as a means of archiving huge volumes of old
paper records. Again, there is no data entry performed as this is a digitized copy
of a handwritten chart. Some of the benefits of a scanning solution such as this
include little or no learning curve, lower initial cost, no change in the way a
physician normally practices and a higher rate of successful implementation as compared
to an EMR system.
Lastly, for those practices that are not ready to leave the comfort
of paper records, there are ways to improve efficiency and make patient charts more
legible. Many medical practices now use handwritten notes on line sheets or blank
paper, often written by the physician. Unfortunately, these types of records are
vulnerable to misinterpretation in audits and so the apparent time savings of a
brief note can prove quite costly. There are several specialty-specific forced-entry
forms available that require checking off or circling of signs and symptoms as well
as clinical findings. These can ensure that the appropriate components for coding
and billing are included in the documentation.
Next: EMR and Imaging Solutions
Peter J. Polack, M.D., F.A.C.S., is co-managing
partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive
surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology
practice located in Ocala, Fla. The practice, which has five locations including
an ASC and laser center, has 140 employees. He can be reached by e-mail at
Ophthamology Management, Issue: August 2006