Case study: Managing paper records in preparation for an EHR

By Barbara J. Robins, FACMPE
March 30, 2012
Body of Knowledge Domain(s): Operations Management, Patient-Centered Care

The challenge

Before we moved to an EHR our practice stored more than 22,000 paper charts on active patients. We also had 570 boxes of inactive-patient records stored at an off-site document management facility, which freed up office space but was not a solution for handling long-term records storage. We spent $6,000 a year on maintaining and retrieving charts from the off-site storage space. In addition to the efficiency and financial incentives of implementing an EHR, eliminating paper records would:

  • Allow the practice to convert the chart storage room into three additional exam rooms
  • Eliminate the cost of maintaining the off-site storage of inactive records

The practice needed to build the electronic medical record for existing charts as quickly as possible and retire the paper charts. This would minimize the amount of time the practice would operate in a hybrid paper-electronic environment.

First steps

  1. Four months before our EHR go-live date we developed a multidepartment team consisting of a physician, myself and other key staff to define the paper chart transition strategy
  2. The team reviewed the process flow of paper charts and staff access to them, as well as the definitions for active and inactive patient records
  3.  The team determined that the electronic charts should be organized a way that was intuitive for providers

Alternatives considered

Keep the paper chart available permanently

This seemed like the easiest option since there would be no additional costs with keeping the charts in the current file room, just the ongoing costs of maintaining an off-site storage facility for inactive records.

Scan the entire paper chart
Benefits of scanning the paper chart included:

  • Minimizing or eliminating the need to pull the paper charts for viewing historical data, enabling the chart to be retired sooner
  •  All records would be maintained in the same location, reducing the risks associated with a hybrid paper/EHR environment
  • Once we scanned the medical records they could be destroyed, freeing up space in the file room for other purposes

Manual data entry of specific data elements

This option would eliminate scanning costs, but the paper chart would still be necessary for reviewing historical data. It also would not allow for one complete medical record and would require the practice to continue to maintain paper charts for active patients. Lastly, data entry could require additional staff.

Chosen solution

The physician partners and I decided to have staff members scan the charts as patients came in for appointments, which would reduce the number of charts that need to be converted at one time. Charts for infrequent patients would be stored for the appropriate retention period and then destroyed.

This option would:

  • Reduce risks associated with a hybrid paper/electronic record by having the entire medical record in one place
  • Retire the paper charts as patients came in for services, thereby reducing paper chart handling costs
  • Allow old charts to be professionally shredded, clearing out much-needed space in the practice

Staff started patient account entry two months prior to EHR go-live by active patients. The practice information technology (IT) staff and EHR vendor programmed and established how and where the scanned data would be stored and managed. The document management vendor provided protocols for what to expect in terms of access to the paper chart during scanning, how the record could be accessed after scanning and quality control methods. Practice management established written scanning protocols.

Lessons learned 

  • The practice should have allowed more time for the chart transition planning and preparation prior to the EHR go-live date
  • Work flow for each provider is different, which resulted in different methods for entering the information into the EHR
  • We trained staff to prep and scan the paper chart two days prior to the scheduled appointment. This is not always possible since the practice offers same-day and walk-in appointments. In those cases, the paper chart was used.
  • We found that EHR vendors only educated the practice on costs associated with their part of the EHR implementation. By interviewing evaluating and comparing costs, conversion methods and references for multiple document management vendors, we selected one who is local and helped us manage costs.

Removing the paper records from their storage space in the practice gave us room for three additional exam rooms, which could potentially result in $481,950 in additional gross revenue based on provider productivity.


How ‘better-performers’ use their EHRs
Simplify your EHR implementation



Barbara J. Robins, FACMPE, administrator, Paseo Family Physicians Ltd.

Article Comments

What do you think?

Please log in to leave a comment.
No comments yet. Be the first!

Latest Print Issues

MGMA Connection
October 2017
About This Magazine
Executive View