Friday, July 07, 2006

Paper chase

We have started to scan and destroy old charts. My secretary said that she just can't believe how much paper we have accumulated over the years, all stored in different locations in the office (current charts, charts of patients not seen for over 2 years, deceased, transferred, part 2 of a large chart, seen offsite at the senior's clinic, piled up for pending consult request, or just plain sitting on the doctor's desk). The time and space taken to manage this is huge.

On Tuesday, we scanned the first paper charts to pdf, had a look at several scanned files to make sure they were good, and tested the back-up. We've also been shredding, but I may send some of that to a commercial shredder. We're putting out five large bags daily; my small office has enough shredded paper to confetti at least one medium size parade. It was very strange to see a filing shelf without the usual collection of crammed, dog-eared files.

I saw a new patient yesterday, and he gave me a copy of his old chart (on paper). Eventually, we'll be able to transfer a chart electronically , but I can't imagine this will come anytime soon. I will review his chart, enter the relevant information in my electronic CPP, and the paper will be scanned to pdf just like the rest of the old charts.

The pop up alerts in the EMR came in handy yesterday. I had seen a patient for a check-up; a recent guideline recommends an ultrasound for men between 65 and 75 who have ever smoked, to rule out an abdominal aortic aneurysm. I saw that on my preventive checklist, when signing off the electronic record (but he was already gone), and put in an alert. The patient returned yesterday, the alert popped up when I opened the chart, and he was sent for his ultrasound. I also saw a patient with Hepatitis C; vaccination against hep A and B is recommended, and public health supplies the vaccine for free. When entering her CPP, I had noticed that she had not been tested for A or B antibodies, and put in an alert for myself to do so. She came in yesterday for another reason, and was tested. I should probably run an audit for Hep C when I'm finished with all the CPPs.

I will be away on vacation at the end of August. I will need to figure out how to let my practice partner (who is paper based) look after my patients. We can print the CPPs for him, scan his clinical notes to the chart, and have him review faxes/mail on paper before scanning. I will show him how to find things in the chart as well, and my staff can help. I do not know how he will handle incoming electronic lab results (I will ask), and I don't think he can print consultation requests from the EMR; we'll have to scan those in. Coverage in hybrid practices is more difficult. On the other hand, any of my colleagues in my FHN can have access to the full chart; perhaps, in the future, coverage will be via "virtual" groups like mine, where the physicians may not be all located in the same office, but can all access the information if needed.


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