Written by Tim Pacek Wednesday, 25 November 2009 11:03

There is not much I haven't seen during an implementation.  I've worked in large multi-specialty organizations, hospital systems, and solo doc practices alike and there is one issue that creeps up in almost every situation.  SCANNING

Scanning is the ugly ducking, the last kid picked for dodgeball, and the one thing that most think that they have a grasp on.  It is also something that can make or break your implementation.  Without a good scanning plan, it is extremely difficult to have an easy transition to electronic health records.  With that being said, there are some major do's and don'ts when it comes to scanning.

Don't create chaos with multiple plans.
It is absolutely imperative, that you create a plan that all physicians agree on.  How much of the chart is going to be scanned?  The past year?  Two years?  Labs?  Discharge notes?  All of these things need to be considered and one uniform plan developed.  More than one plan will cause confusion for the staff performing the scanning which will ultimately lead to confusion for the physicians trying to find the information in the system.  Create a plan and stick to it throughout the entire process.

Do remember that "Less is more."
Some physicians want to scan every piece of paper that is sitting in a patient's chart.  This would not be an issue if it is a patient that they have only seen once or twice.  However, we all know that there are charts that exist in every practice that could match the Oxford English Dictionary pound for pound.  Scanning everything is simply too much and unnecessary.  Develop a plan for scanning extraneous items after go-live.  The physician can flag what parts of the chart he/she would like to be added to a patient's electronic record.  This will save time for those scanning and also save the physician from looking through information that he/she doesn't need.

Don't skimp on your resources.
This includes personnel and equipment.  Scanning is extremely resource intensive.  Don't use your office manager and other key staff members when scanning.  Many of my clients have opted to hire temporary staff (i.e. college students on break) to help with the scanning load.  (I do not recommend having staff add medications, allergies, and problems unless they have a clinical background so a two-tiered process may be required here.)  Also, buying the right scanners and enough of them is also important.  You will not only need scanners for the front desk to scan insurance cards and driver licenses but you will need scanners for clinical staff to add items to charts after the physician has flagged them and bulk scanners to prepare charts before patients even walk in the door.

Do chart abstraction.
Create a new face sheet for your charts so you can document medications, allergies, and problems cleanly.  This will save time and errors when preloading patients in the EHR.  It is also a good idea to have every chart organized the same way so it is easy for the staff who are scanning to identify what each paper is.  Most importantly, you must develop standard naming conventions that will be used consistently throughout the entire practice.  Do you want to have a separate description for every x-ray, have them all read just "x-ray", or something in between.  Taking a little time to be organized will save you many headaches in the long run.

Don't wait!!!!!
I cannot stress this to you enough.  Scanning is a long and arduous task.  It is not something that will be done over night.  In fact, you will never be done with scanning!  However, if you start early and do it right, you will make your implementation much smoother.

Just think of how nice it will be when you will no longer have to call someone to bring you a chart, or go searching for one yourself.  Giving your scanning plan the attention it needs will limit much of your frustration during go-live.