From Paper Files to Electronic Health Records

Copyright, Lehigh Valley Business magazine

In recent years, few regulatory changes have caused a bigger stir than the electronic health records mandate.

The mandate – originally part of the American Recovery and Reinvestment Act of 2009 – called on health care providers and hospital systems to fully embrace electronic health records. The goals were improving quality and safety of care, reducing disparities and inconsistencies, better engaging patients, increasing care coordination and ensuring security and privacy.

Two years past the Jan. 1, 2014, deadline, the initiative has been largely successful, at least from an adoption standpoint. According to, 74 percent of office-based physicians and 97 percent of hospitals possess certified EHR systems. These numbers represent dramatic increases over pre-mandate EHR adoption rates and show widespread acceptance of digital medical records.

But there’s a wrinkle. Health care facilities exist in the real world – not the digital one. That means there will always be some records and forms that must start on paper, rather than on a screen. Integrating these into the EHR system is mission-critical, as a highly accessible “single source of truth” is the entire point.

So, how does a health care facility go about digitizing new paper records? It’s more complex than just scanning. Two main considerations when integrating paper with EHR are correctly designing the forms and trusting the pros.

1. Design the Forms Correctly

  • Encourages the user to include all necessary information.
  • Does not contain distracting or irrelevant elements.
  • Is easy for the user to read and follow.
  • Is designed for optimal scanning efficiency.

The first three items are obvious. Cluttered, illegible documents always are bad. But what about that last item? How can something as seemingly simple as a graphic design choice reduce the need for additional manual efforts before, during and after scanning?

Think about this: Have you ever filled out a paper form that contained a surprising amount of red? It’d not there to be pretty; red is a standard drop-out color. Essentially, the scanner can be told to ignore all red elements and focus only on black – to skip the instructions (in red), and capture the relevant information written by the user (in black), for example.

How about forms with individual blocks for letters or numbers? Again, that’s for imaging. Properly separating characters is essential for many optical character recognition solutions – the software that recognizes handwritten letters and turns them into typed text.

Professional form designers are very good at creating documents both easy to fill out and optimized for scanning. It’s a foundational piece of the puzzle – and one that is absolutely key for ongoing EHR management. Imagine, for instance, if a hospital uses third-party anesthetists on a contract basis. They have paperwork to do, same as full-time hospital staff. But since they’re not hospital employees, they likely don’t have access to directly input information into the EHR front-end. That means they’re recording information the old-fashioned way: On paper.

Unless the hospital hires a fleet of data entry clerks to manually type all of the anesthetists’ forms, they will need to be scanned. The better the form design, the easier this is. Information can be extracted automatically and accurately and imported into the system of record. Conversely, if the form is poorly designed for imaging, constant exceptions can bog down the system, creating unnecessary manual tasks in what should be an automated workflow.

2. Trust The Pros

Health care providers are really good at providing health care services – not processing documents. Tapping the services of a professional workflow automation firm can be significantly less expensive (and much more effective) than trying to handle paper-EHR integration in-house.

Think about data quality. How much would it cost for a hospital system to hire one or two full-time employees whose sole focus is setting up and maintaining the systems and processes to ensure the integrity of EHR information? A full-service document processing and workflow automation vendor can easily handle even the most complex tasks – multiple database lookups, validation according to business rules, etc. – it’s all part of the scope of work.

That’s just the tip of the iceberg. From initial forms design and workflow setup to final quality control and system integration, business process automation professionals have skill sets that most health care providers simply don’t. With the right vendor, procedures can be put into place to ensure strict confidentiality and Health Insurance Portability and Accountability Act compliance. Documents can be securely transported and even stored in segregated, locked parts of the warehouse. If your partner knows the industry, they’ve dealt with the pitfalls – and learned to overcome them.

– By Tom Kolepp