A proper backfile conversion is key to EHR implementation success

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I recently spent some time participating in a LinkedIn discussion about the most common reasons behind the failure of electronic health records implementations. As I thought through my posts, something dawned on me: The key to successfully transitioning to EHR (or EMR; whatever your preferred acronym) is part and parcel with the mission of AIIM.

EHR systems can be extremely expensive to implement. The process takes months or years, and routinely costs millions of dollars. In short, it’s a significant investment of time and capital, even for the most well-funded hospital or healthcare institution.

Naturally, they’re going to want to get the most out of their investment. But if a hospital doesn’t incorporate its legacy backfile of patient records into its EHR plans, it won’t. Failing to account for records created before the launch of a new system essentially creates two methods of patient care – one using an automated platform, and one that requires costly, inefficient file storage and paper pushing. It’s the worst of both worlds.

Fortunately, with today’s software, technology and techniques, it’s relatively easy for hospitals to manage their backfile in conjunction with an EHR implementation – thus avoiding a key reason such systems fail. A properly completed backfile conversion lets a hospital manage its records efficiently, share information effectively and take full advantage of its EHR investment. And all that adds up to better patient care.

There are several things to consider when it comes to hospital records. In order to make backfile conversions run in conjunction with EHR implementations go smoothly, vendors and institutions need to pay attention to these points:

  • Outsourcing the backfile conversion is typically an afterthought in the vast majority of companies and organizations. But hospitals and healthcare, professionals cannot view patient history the way a business may view legacy paper files. Still, many systems vendors routinely present the process of scanning and capturing patient charts as a simple DIY project. Once the sale is made and the equipment installed it is left to fail due to the complex nature (and sheer number) of patient charts. Does it really make sense for an overworked staff that is trained to be healthcare practitioners to become proficient at scanning and indexing patient records? Even worse, some leave the process to temporary help or interns.
  • Still, many healthcare institutions have tried to convert patient records themselves. Why? Security, compliance and regulatory threats. It’s important for healthcare institutions to know that top outsourced imaging vendors are HIPAA-compliant and completely secure (with the ability to bring their equipment and trained staff on-site). At least when it comes to the top tier of imaging specialists, the perceived risk of using an outsourced service is far greater than the actual one.

Hospitals are moving toward EHR rapidly. But too often, they’re forgetting their patient history – which is just as important to the success of the system as any new records generated digitally. By converting legacy systems and using an expert to make all records – no matter when they were created – electronic, healthcare institutions can ensure they’re getting their money’s worth when it comes to EHR. 

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Gordon Hoke

Long term preservation of EHR

Health records need to be retained for the life of the patient -- longer if genetic pre-dispositions can be applied to a second generation. Retention is longer still if genetic longitudinal studies are active.
If you migrate paper to digital formats, how do you propose to overcome obsolescence of application software, operating systems, storage media, hardware, formats, etc.? Do you want to trust your health to a supposition that, say, PDF or TIFF files stored on disks or tapes will still be available in 25 years?
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Gregory Bartels

Long term document retention

Great questions Gordon.

Long term document retention is an ongoing question from paper to microfilm to optical discs systems and now to newer digital technologies. Many organizations including governmental agencies have gone the route of storing the documents in both a digital and analog format (albeit microfilm) to deal with the requirements of long term retention. Many rely solely on digital platforms.

IMHO, paper retention systems are not good long term options. Paper deteriorates over time and usually has no form of backup. Recently we have experienced the total destruction of several large offsite paper storage facilities due to fires and the incredible tragedy of 9/11.

On a recent visit to the Library of Congress in Washington DC I noticed many of the books from Thomas Jefferson’s library (http://www.loc.gov/exhibits/jefferson/jefflib.html) were lost due to two fires. These records are lost forever yet would be accessible if standard electronic document management principles were available then. I also noticed that several of the books were checked out for preservation which includes scanning and digitally storing these books and documents for future generations.

Most organization realize the need for duplication and a physical separation of the location of records for proper long term retention. No medium serves this purpose better than a digital medium. The transformation of Patient Health Record is evolving and will only accelerate in our lifetimes. Take it from the experts at the Library of Congress that used properly digital records are here to stay (http://www.digitalpreservation.gov/personalarchiving/documents/media_durability.pdf) (http://www.digitalpreservation.gov/multimedia/videos/personalarchiving.html).
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