Avoid the Pitfalls of Centralized Document Scanning for EHRs

One of the most attractive promises of EHRs is that all that paper in a medical office will disappear.  The natural assumption, which is true as far as it goes, is that information currently captured electronically will be stored and transferred electronically.  But what about historical records of the practice and documents delivered by patients or other physicians?

The answer in many large organizations, and for many practices affiliated with large organizations, is that any paper documents will be sent to a centralized facility for scanning into electronic images and attachment to the patient's electronic chart.

This makes sense for several reasons:
• High-speed, high-quality scanners are expensive.  To justify the expense, they need to handle a high volume of documents, which does not exist in individual practices or pods.
• Handling a high volume of documents requires skilled operators who know how to take advantage of the full set of scanner features to increase throughput.
• Documents attached to the wrong chart can be lost forever.  Skilled operators, focused on the task, should be more reliable than general office staff.
• Protecting the investment and safeguarding the paper documents requires a secure setting, accessible only to people with a reason to be there.

Nothing is ever perfect, however, and centralized scanning has two primary downsides:
• The documents have to be transferred from the individual medical office or pod to the centralized facility, even if it is within the same building.  That exposes them to loss, misdirection, and accidental destruction.
• From the time the documents are taken from the individual office or pod until they are scanned and attached to the right patient's chart, they are usually unavailable. Keep in mind that the people responsible for the scanners do not ever want them to be idle.  They like the idea of a backlog of documents to be scanned, and often are proud to promise that documents will be scanned within one to two weeks of receipt. 

If the office starts copying documents before sending them to scanning, it is a lot of wasted work and expense. It also opens up exposure for the documents kept at the office. A single document can be found, but it is usually the proverbial needle in a haystack.  It is generally better to use the resources required to locate it to keep the scanning process moving forward.

Here are the three most important questions to ask when someone implementing an EHR says they are going to centralize document scanning: 
1. How are the documents secured in transit? What are the specific safeguards?
2. What is the maximum amount of time between taking the documents from the medical office and having them available for electronic access? A really good imaging department will understand the need for documents to be readily available and will only take documents it can process within one to two days.  Centralized scanning generally makes sense only when paper charts or parts of charts are being scanned as a part of the conversion.  The volume of current paper documents coming into the practice is usually low enough to argue for an inexpensive scanner in the office.
3. In the case of an emergency, what provision has been made for locating a document in transit or in process?

Electronic documents save enormous amounts of time and space, but until they are actually available the office must be able to get to the paper when necessary.