Hospital Chain's Digital Conversion Takes Patience, Time

When a hospital transitions to an electronic medical record system, it doesn't get to throw out the tons of paper and film records it has collected over the years. In fact, most healthcare providers that go digital find they must retain a lot of paper and film for quite awhile.

Record retention regulations prevent hospitals from dumping patient information. These rules, which vary from state to state, force hospitals to keep patient charts and images for anywhere from seven years to the life of the patient and beyond.

That can translate into a lot of paper and film that has to be either physically saved or electronically scanned and stored.

For older hospitals making the electronic switch, that means coming up with a plan to hold onto existing paper-based patient data even if their future is digital.

Many healthcare organizations have multiple rooms storing paper charts and others for radiology films. On top of that, most have off-site facilities storing older records that aren't likely to be used anytime soon but must be retained for legal, regulatory, and other reasons. Even if a hospital is going electronic moving forward, it's not likely to digitize all its paper-based records.

Exempla Healthcare in Denver is tackling this issue as it migrates two older hospitals onto a new Epic EMR system. A third newer hospital, Good Samaritan, opened in 2004 with e-medical records and other computerized clinical systems, but it wasn't 100% paperless from the start so it also has some physical record storage needs.

Last month, Exempla's St. Joseph Hospital, which has 565 beds, went live with its Epic EMR system, and by November, its 400-bed Lutheran Medical Center will go live. Prior to the EMR move, the hospitals had multiple rooms storing charts that were less than six months old, plus a number of other rooms storing radiology film. A third-party company stored and managed records offsite that were older than six months old.

The hospitals just didn't have enough space for anything older than six months old to be stored in-house, said Barbara Manor, Exempla director of information management. When a patient returned after six months, their records had to be moved out of storage.

Every day hundreds of records had to be pulled by the third-party storage company, and only half to doctors needing them got them the same day, Manor said. That meant doctors had to look in multiple places to find what they were looking for or wait for charts and X-rays to be delivered, she said. As Exempla planned its EMR strategy, it decided to consolidate the paper and film records. It hired RMS, now owned by Iron Mountain, to re-engineer, store, and manage its records.

Over several months, paper records, and film jackets were moved from Exempla's hospitals to an offsite building. They were inventoried so that patient charts and films that needed to be pulled during the transition could be delivered quickly to doctors, Manor said.

Following Colorado's medical retention rules, during the conversion, records older than 10 years for adults who were no longer patients were destroyed. Records for children need to be retained until they were 28 years old, she said.

"We had 14-1/2 miles of boxed records with files for about 1.6 million patients, Manor said.

Exempla isn't back-scanning old paper-based records, though it did scan into its document imaging system discharge records of patients treated at the hospitals during the conversion period.

Exempla also implemented a picture archiving and communication systems to replace film X-rays with digitized medical images. Film-based X-ray images of current patients were scanned so radiologists could electronically retrieved them.

With the new EMR going live, Exempla doesn't want to drive paper records back and forth from the storage facility when a patient returns for care, Manor said. Rather than pulling those paper records, storage staff scan pertinent files into Exempla's CGI document management system. Soon, doctors will also be able to access those images directly via hyperlinks in the digitized charts on Exempla's EMR system, Manor said.

Exempla will continue exist in a paper and digital world for a while, until all its older paper and film-based records can be legally destroyed. Meanwhile, doctors are already seeing the benefits of going digital, Manor said.

"We're bringing all information about a patient into one place," she said. "Before it took much longer for doctors to find what they were looking for."

The big bonus in all this: Exempla estimates its annual record management costs have been reduced by about 20%.

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