Digital records are good, but what about all that paper?

Electronic medical records are a unique proposition. While just about any IT installation has to integrate with existing databases or networks, very few are crippled without uploading a bunch of data stored on paper. Right now, physicians and hospitals with EMRs are forced to use ad-hoc solutions when they want to access paper records, but that approach isn't sustainable.

Today, some tech-savvy physicians are capturing the records they need for a particular patient with their iPhone or a handheld document scanner, a short-term solution that has some value. And hospitals can manually pull records when needed by a particular provider, such as an emergency services team, if the patient's history isn't in their EMR.

The thing is, adding manual or patient-specific processes to the mix does nothing to standardize the process of bringing  past records online. In fact, looked at one way, they actually make the health system's problems worse, as any additional layer of processes can only add confusion to the mix. For example, if a doctor photographs a patient record, there's no way to update it, which undermines their ability to respond to changing patient needs.

While I have no hard data on this, my sense is that most providers have decided to punt, relegating the issue of paper records to the "we'll handle it someday" bin. It's telling that on the vast exhibit floor at HIMSS this year, OCR scanning and document management solutions weren't very common. Vendors have their ear to the ground--they have to in order to survive--and know what their customers are worried about. Apparently, they aren't being deluged with requests to get that paper-based data online.

I'd argue, however, that the humble, time-consuming grunt work of getting paper records into your clinical data systems is just as important as putting the systems in place. If the purpose of installing those systems is to offer rich data to physicians--and to HIE partners--it makes no sense to only provide information that gets entered after your EMR gets cut over to production status.

Sure, digitizing paper-based data of any kind is a pain in the neck, requires a host of moderately-skilled coders who may require close supervision and costs a great deal over time. Worse, over the short term the efficiencies you generate may rebound more to health insurance companies, who save money as you get more efficient.

Still, it's just about impossible to meet the goals of a digital health record without including history and context. After all, there's no point in truncating medical data if the idea is to make a complete picture available to everyone. So it's time to bite the bullet and get those massive piles of paper charts online. Just grit your teeth and get it done; you'll be glad that you did. - Anne

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