Posted by: notdeaddinosaur | April 19, 2012

Papering the Paperless Office

Holy crap! It actually happened.

Three and a half years ago, I wrote this about the procedure for a chart audit in an office with an electronic medical record:

Each entry in the medical record within the designated time frame must be printed out (on…say it with me, boys and girls…PAPER) for her to feed through her spiffy little portable scanner, one page at a time, to enter the information into her computer.

Guess what happens next? (You just know what’s coming…)

All those printouts must then be shredded.

Someone tell me again how much more efficient and environmentally friendly the paperless office is going to make us all?

About a year and a half ago, as both of you regular readers know, I switched from paper charts to an electronic system. For the first time since then, one of the insurance companies sent someone to my office for an audit. The nice lady with the nice little computer and portable scanner set up shop, although this time I had to vacate one of my work stations so she could log onto my EMR to print out all the information from the charts she needed: every single visit, letter, x-ray report, hospital record, and correspondence from 2011 on each of twenty patients. Half a ream of paper — that she provided, luckily. Too bad the printer toner was on my nickel.

Then she scanned them, one sheet at a time, through her cute little portable scanner (as opposed to mine, that can scan up to 50 pages at once). Then she had to go through each page to extract the data she was really looking for and enter it into her computer, even though she still needed to scan it all.

And then we had to shred…it…all.

What a waste.

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Responses

  1. Oy.

  2. You certainly aren’t alone. I can’t give you links but there is no doubt that computerizing your business–not just the EMR phenomenon–increases the amount of paper, sometimes by huge amounts. When i was at the UNC Medical Center in 1999, beta testing a program for a paperless L&D chart, JHACO requirements MANDATED a parallel paper chart, and certain required forms such as consents HAD to be in paper. It drove us crazy,but the nurses felt terribly vulnerable without their reams of paper. One actually told me that “the computer wrote that, not me” even though the computer only printed out entries she had made. I wanted to find her a goose quill which was about her technological level.

  3. Next time, tell her your negociated fee schedule is $5 per page for printing, payable in advance.

  4. If it is not the insurance company and a subcontracted third party, then you can charge for the record copies.
    My local hospitals have been using partial electronic records since 1/2011. They pay staff to sit in front of computers and sheet feet paper documents. On admission and discharge, instead of simply writing the orders for home meds and writing prescriptions for new discharge meds, I have to sign around 7 pages of typed med lists on each page. Each page has to be signed and dated. Also there are not enough computers to lookup vitals on the patients. The EMR is not saving me any time.

  5. “If it is not the insurance company and a subcontracted third party, then you can charge for the record copies.”

    Most contracts with insurers are written along the lines of “make records available,” not to actually provide copies of the records.

    It is completely appropriate to make said insurers pick up all the costs of copying records, if that is what they want.

  6. Stupid question, but has anyone thought about printing the documents to PDF and handing them to the insurance auditor on a USB stick?

  7. @bobby: Yep. That’s the first thing I offered, as the documents are already PDFs. Not good enough for them.


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