Strategies for Scanning Old Chart Documents into your EMR

One of the strategic issues facing medical practices that are moving from paper charts into an EMR is the question of what to do about old paper chart information. Should there be an exhaustive attempt to scan all the old charts and import them into the EMR? Some practices have elected to do this. Or, should one be more selective, and if so, then what sort of selectivity should be applied?

In practical application, the older the data in the chart becomes, the less useful it is for day-to-day medical decision-making. An exhaustive scanning and importing of old chart information is probably wasteful of time and resources, and may delay implementation of the EMR into your practice. Yet there is some information that in indeed useful – items like old EKGs (for comparison to future ones), old mammography reports, or colon cancer screening reports (or any other HEDIS data point that can be the basis of good medical practice as well as Pay For Performance reporting) – these sorts of selected items may well be good to have in the EMR at the outset.

Some practices have hired a medical abstractor clerical person to go through all the old charts and pull out the selectively-desired items for mass scanning. That can be daunting and expensive. Another approach (one which I believe is more practical) is to pull the paper chart when seeing the patient (just like always), and use it alongside the EMR. Then the desired “old” pages can be pulled from the paper chart as-you-go, set aside for scanning and importing into the EMR, and then the paper chart can be retired to off-site storage. Over time, the number of patient visits for which there is still an “un-retired” paper chart diminishes.

One can always retrieve an old paper chart from offsite storage for looking through detailed entries (e.g. if your records are subpoenaed several years after-the-fact), but over time the frequency with which this comes up becomes astonishingly small. After about a year, it is likely that you will seldom need or see your old paper charts.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion, Inc.