Hospitals Don't Always Plan for 'Hybrid' EMRsHospitals Don't Always Plan for 'Hybrid' EMRs

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As hospitals transition to electronic medical records (EMRs), many are not adequately planning for the intermediate period when they might be running dual paper and electronic systems, a records management firm says, based on results of a survey.

"I don't see a real, well-defined way of dealing with the hybrid [paper-electronic] world," Ken Rubin, senior vice president and general manager for healthcare at Iron Mountain, told information Healthcare. Instead, Rubin said he sees kind of a "no-man's land" between paper and digital recordkeeping.

"We see a haphazard approach to scanning [paper records]," Rubin said, referring to a survey of hospital-based information managers.

Boston-based Iron Mountain released survey results earlier this month just ahead of the first anniversary of the publication of the final stage 1 rules for "Meaningful Use" of EMRs.

According to the survey, 70% of the 201 health information professionals queried in April expect that their organizations will achieve Meaningful Use this year. But only 14% expect to be rid of paper records within a year. That means that there will be a fairly long transition period, and that worries Rubin.

"It's going to retard the true 'Meaningful Use' of EMRs," he said. Even though the regulations to qualify for federal incentive money really only address future patient visits, not what healthcare providers should do with existing paper records, Rubin said that dual paper-electronic methods are inefficient and costly--and may not convey a sense of urgency to change-averse physicians.

"The faster you can get to the other side, the faster you'll get physician adoption," Rubin said. "If we can get rid of their 'binky' and drive toward the EMR, they we'll get to the adoption faster."

About one-third of hospitals surveyed have decided to scan all paper records, even those that are redundant or outdated. Nearly half of larger hospitals have completed scanning plans, but only 23% of hospitals with fewer than 150 beds have.

But scanning and management of paper records often is not well coordinated with an EMR implementation. More than half of all survey respondents did not know what their scanning budgets were and a mere 5% could say what their cost per scanned image was.

About three-fourths did report having clear policies regarding scanning, filing, and shredding of paper records, though a small portion of those only had such policies for active records. Approximately two in 10 did not have any sort of policy.

Rubin also expressed concern that many hospitals were not deploying the right kind of staff to record conversion. Full-time file clerks do the scanning in about 29% of the organizations represented in the survey, something they might not be adequately trained for. "Two-thirds to three-quarters of them would not be able to be hired by a scanning company," Rubin said.

According to Rubin, scanning professionals really need to know what parts of the chart are most useful to end users--clinicians and billing coders--and they should understand how to index scanned records. Low-paid file clerks do not always have those skills, he said.

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