Migrating from Paper to EHRs in Physician Practices - Retired A successful transition from paper-based charts to electronic health records (EHRs) in the physician practice or clinic requires careful coordination of many moving parts. A myriad of challenging and complex decisions must be made, ranging from selection and implementation to training and maintenance. Failure to adequately evaluate the clinical workflows and information needs associated with providing care and a lack of planning during and after go-live will result in a fall back to paper, thereby jeopardizing the success of the EHR adoption.

This practice brief outlines the considerations and decisions that must be made for an effective migration from paper to EHRs within a physician practice or clinic. It also provides recommendations about what to do with historical patient information contained in the paper records that exist at the time of the changeover. Decisions, Decisions Physician practices and clinics must consider the following questions when transitioning to EHRs:. Which historical patient information should be available for patient visits during and after the transition?. What are the best methods of converting this information to the EHR?.

What is the best way to ensure that the converted data and information is of sufficient quality?. How long should the paper record be available after the conversion?. How long do paper records need to be kept after the transition to the EHR?. What is the role of printing and should it be allowed during the transition? There are no one-size-fits-all answers to these questions. However, they must be considered and will largely be driven by two factors: the types of medical specialties and users in the practice and the information management resources available to the practice.

The Needs of the Practice Clearly the type of patients seen in the practice will dictate what and how much historical patient information should be converted in preparation for EHR implementation. Primary care and certain medical specialties such as cardiology generally need more historical information, which requires more types of information such as past diagnoses, diagnostic test results, medications, and significant past medical history. Other specialties whose services are more episodic or consultative, such as orthopedics, may have less need for historical patient information.

A multispecialty practice with these specialties will have to obtain consensus from all stakeholders as to how much patient history to include within its EHR. Practices will need to identify which patients’ health information will be included in the conversion. For instance, will the records of all active patients who were seen recently be converted, or will the conversion be undertaken only upon scheduling of a new appointment or service? Deceased patient records must be stored for the appropriate retention period and should not be scanned into the system.

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This will allow for all resources to be effectively used to convert current patients. Use of Paper Records In planning its transition to the EHR, a practice must determine how paper records will be used during and after the changeover, including printing permissions and restrictions. In the absence of clear guidelines, either activity can easily grow out of control. Circulating Paper Records Practices must determine which patient records to convert to effectively make the transition. The appointment schedule can be used as a guide to ensure all patients scheduled have their records converted.

Once a paper record has been converted, staff should use the paper version only as a reference. Practices should clearly document and communicate these expectations to staff. Practices can use reminders and notices on converted paper records to ensure that providers do not add new patient information to these records. Factors Affecting the Use of Paper Records Many factors can affect how long a practice uses paper records. The longer a practice uses paper records, the more it will hinder the success of the conversion.

In order to gauge how long and to what extent paper records will be used, practices should examine the method of the rollout during the planning phase of the conversion. There are two types of rollouts: big bang and staged.

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In a big bang rollout the whole practice converts to the EHR at the same time. In a staged rollout, the conversion occurs in phases, usually by specialty in multidisciplinary practices or by location in larger practices.