Dwight;

This is great stuff.
Your message could easily become a ARMA Conference session worth paying for
and recommend attending.

My document conversion clients are currently seeing increases in scanning
both paper and microfilm for the healthcare industry.

There is one  comment from
(http://www.osnsupersite.com/view.aspx?rid=41469):
“We're working on a visual field standard, so that’s kind of exciting,” she
said. “So finally, instead of having a paper or a PDF of the visual field
report, there will be actual data that you can transfer between the visual
field machine and the EHR system."
The need is for the data and not necessarily the image but the records
manager will have to deal with the paper, the image, the data, and all
their respective indexes.
I don't think the average document scanning vendor sees this.


...John Glover
...707-773-1257
[log in to unmask]
516 Albert Way
Petaluma, CA 94954
www.linkedin.com/in/johnrglover


> [Original Message]
> From: WALLIS Dwight D <[log in to unmask]>
> To: <[log in to unmask]>
> Date: 7/10/2009 8:57:28 AM
> Subject: [RM] Federal Electronic Medical Records - another perspective
>
>  
>
> Given some of the comments/characterizations appearing lately regarding
> the federal electronic medical records initiative, I did a bit of
> research, as I was concerned. It appears that the reality is somewhat
> more mundane, quite a bit more hopeful, yet also a bit scary. In other
> words, it's a fairly typical (albeit rather huge) records conversion
> process. I compiled some of those links - sort of a RAIN guided tour
> with notes - to help provide some context. I tended to focus on articles
> and sources that are relatively recent - generally within the past 3 - 4
> months:
>
>  
>
> The following link may prove helpful. It is a concise explanation of the
> federal governments official definition of an electronic medical record
> system:
>
>  
>
> http://patients.about.com/od/electronicpatientrecords/a/emr.htm
>
>  
>
> Specifically:
>
> "The federal government has defined a complete EMR system
> <http://www.cdc.gov/nchs/pressroom/06facts/electronic.htm>  as
> containing four basic functions: computerized orders for prescriptions,
> computerized orders for tests, reporting of test results, and physician
> notes. An individual doctor's practice, facility or insurance company's
> system determines on its own which of those records will be kept, making
> it more or less complete. Federal definition has not resulted in a
> standard." While I was able to find some information on cloud computing,
> large centralized data mining, HIPAA modification etc... I would say
> that such information tends to fall into the realm of "vision" or
> "punditry" and less the realm of reality. Note, however, that the
> legislation regarding this effort is still being hashed out in Congress,
> and much of the speculation surrounding this initiative seems related to
> that lobbying.
>
> The following is a fairly typical and detailed representation of how
> this is being approached within the medical profession, in this case by
> opthamologists:
>
> http://www.osnsupersite.com/view.aspx?rid=41469
>
> Note the time frames being discussed, and the emphasis on data
> portability between medical devices/systems and within or between
> entities. Note also the emphasis on standards development, and the
> references to various certication authorities, including the
> Certification Commission for Healthcare IT (CCHIT). Compliance with this
> particular group's standards is not currently either federally supported
> or required. More on this later.
>
> Looks like some big players, such as General Electric, are already
> lining up:
>
> http://www.google.com/hostednews/ap/article/ALeqM5iRZ-b-pPFOy9xZY_gVh65P
> elrQXgD98R67GO0
>
> As noted, there is a considerable amount of lobbying going on. This next
> article may explain some of the fears expressed as a federal report
> "shines the light on Google's EMR lobbying efforts". I see very little
> indication that this particular lobbying is being effective:
>
> http://www.healthcareitnews.com/news/federal-report-shines-light-googles
> -emr-lobbying-efforts
>
> The proposed National Health Information Network may be the "massive
> system" people are concerned about:
>
> http://www.eweek.com/c/a/Health-Care-IT/Sun-Software-Key-to-Electronic-M
> edical-Records-Network-150901/
>
> This is not a cloud computing proposal, although it's less clear
> regarding the potential for data mining (which can be both a good and a
> bad thing, depending on how it is used). The NHIN is more a proposal for
> a secure data network, in line with the repeated emphasis on data
> portability, and, obviously, security is the key. However, let me simply
> point out that secure networks are not exactly a new phenomena.
> Insurance companies, our national security apparatus, and all sorts of
> critical entities have been utilizing them for years.
>
> The speed of this endeavor presents challenges, to say the least,
> although most time frames tend to hover in the 5 to 10 year range. This
> article from the NYT is one that captures those concerns effectively,
> concerns that should be familiar to records managers:
>
> http://www.nytimes.com/2009/03/26/business/26health.html
>
> There are also concerns being expressed about CCHIT (remember them)?
> This IT industry group has not yet been specified as the required
> standards body (although it could be):
>
> http://www.ihealthbeat.org/Articles/2009/5/21/HIMSS-Calls-for-CCHIT-To-C
> ertify-EHR-Systems-Critics-Express-Concern.aspx
>
> I hope this proves helpful in clarifying some of the issues surrounding
> this effort. As I mentioned before, we just recently made the transition
> to electronic medical records keeping. Our involvement centered on
> policy issues such as HIPAA and medical records retention, as well as on
> dealing with the legacy hard copy. Regarding the latter, I thought it
> might be useful to share our experiences as a sort of "heads up" to
> those on this listserv with the responsibility of storing medical
> records. It gets into the implications of what these systems are trying
> to do, and how they operate, and the impact that will have on your
> storage situation. In a nutshell, I'm suggesting that you be prepared
> for a potentially large and rapid influx of volume. 
>
> These systems do not result in immediate paperlessness, but they do
> result in high volumes of suddenly inactive case files.  Partly this is
> due to their reliance more on data abstracting, less on traditional
> image capture. To be blunt, this is because one of the principle
> problems with current paper based systems isn't necessarily the paper
> media; it's the notoriously bad handwriting of doctors. The key
> transition here is not the media transition, it's the transition from
> handwriting to direct data entry. If you scanned the paper, you would
> simply be transmitting the problem into the new system. 
>
> The paper files are kept during a transitional period to provide backup
> to correct any errors, or fill any gaps missed in the initial
> abstracting stage. This takes time, as its not necessarily practical to
> abstract everything, particularly if you are in a high turnover medical
> situation where a good percentage of your clientel may never show up
> again, or may show up 6 years down the road (the case, for example, with
> the outpatient clinics we operate in the county). Moreover, the
> incentive to immediately transform low productivity file space into high
> productivity medical space is overwhelming and drives this process,
> largely because that medical space can generate direct revenue to a far
> greater degree than more typical office space. 
>
> In our case, that transitional period is currently set at 10 years.
> During this time, the "record copy" will gradually transition from the
> paper file into the electronic system - essentially an "abstract on
> demand" process. Of course, the accessioning of new files stops to a
> large extent (though not entirely), and we anticipate a steady drop in
> record actions during this time. Again, this has been our own
> experience, but given the nature of these systems, I have a feeling it
> may prove to be fairly typical.
>
> I hope this is helpful to folks.
>
> Dwight Wallis, CRM
>
> Multnomah County Records Management Program
>
> [log in to unmask]
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