Dear HIS Pros,
I am doing a project on EMRs for my graduate IT class at Xavier University in Cincinnati. My own topic centers on what happens to all the valuable data in the legacy paper records come day-forward? I read that many physician groups are simply scanning them into pdf format so they can be stored electronically, but this makes the files worthless from a data mining/ physician query standpoint. It occurred to me that your pros, as the experts on cradle-to-grave EMR implementations, would be a perfect source for my project. Could you ask the pros to answer a few questions regarding this?
- What options exist to convert all that legacy data into a standardized EMR data format?
- What are the cost/benefits associated with doing that?
- While research powerhouses like Johns Hopkins and Mayo Clinic might find all that legacy data necessary in their implementations, how useful would the run-of-the-mill physicians group find having that data integrated into their EMRs? Would it depend on the patient population (eg peds vs geris?)
Of course, any other relevant info you might volunteer would be welcome.
A strategy for importing legacy data from the paper chart into an EMR is an important component of an EMR implementation. Typically, a combination of scanning and discrete data entry is utilized to load data from paper into the EMR system.
Items that are entered as discrete data include: Problem list, medication list, allergies, lab values as deemed pertinent by the provider, recent vital signs, dates of pending wellness exams (colonoscopies, mammograms, etc). Family and social histories may be entered by the provider’s staff or the patient may be asked to complete a bubble sheet form, which is then scanned and imported into the system as discrete data.
Elements of the chart that are scanned are those that will continue be stored as text in the electronic record: progress notes, consult letters, discharge summaries and other text.
The costs of the electronic data load vary depending on who is doing the work. The data entry is usually performed by individuals with clinical training such as a medical assistant, RN or (most expensively) a physician.
Scanning can be performed by clerical staff, and many practices hire college students or other temporary employees to perform the scanning. In terms of time, the data load typically takes about one hour per chart.
The amount of scanning and data entry will vary by specialty. Providers need to determine what data is pertinent and how far back in time to capture the data – for example a normal mammogram report from ten years ago may not be relevant going forward and will not need to be scanned. We find providers initially over estimate how much data needs to be converted from the paper to the electronic record.
An interesting topic is the conversion of data from one electronic medical record system into a new system. The CCD (Continuity of Care Document) standard interface transaction format is the method envisioned to migrate data between EMR’s, however the EMR products in use today vary in their ability to export and import CCDs. Any provider who is contemplating replacement of an existing EMR system should consider this capability when making product selection. Without the ability to electronically migrate discrete data from one EMR to another, the conversion process will involve a combination of data entry and loading of PDF files, nearly as laborious as converting from paper.
Good luck with your project and please let us know if you have additional questions or need clarification.