VITL Summit

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Pre-Loading and Scanning

• VITL Summit
• September 24, 2009

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Data Migration
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Data Migration Transferring information
currently in the paper chart into the electronic
medical record (not discussing Practice
Management)
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Why?

• Speed and Efficiency Able to have your patient
  information at hand
• Safety Having information in one place as soon
  as possible
• Data Collection The sooner the data is entered,
  the sooner you can get reports
• Cost/Space Savings Reduce retrieval and storage
  costs

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Methods of Migration

• Scanning Entire document is electronically
  loaded and stored in the electronic medical
  record
• Pre-Loading Loading patient information by
  typing it into specific data fields in
  appropriate sections of the electronic chart

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Where are you going?...

• Paperless or less-paper office?
• Paper charts on or off site?
• Eliminate or minimize chart pulls for visits or
  phone calls
• Reduce filing time

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Its a lot of work!! But its worth it!!
REMEMBER The of charts preloaded is a very
important factor in your success at go-live!!
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Also Remember

• The old charts will still exist in some form or
  another , so please

DONT PANIC!!
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Scanning

• Do as little as possible (unless you are storing
  your charts electronically)
• Enters documents as an image or text, not in data
  fields, so not searchable or reportable
• Use for documents such as
• Progress notes
• Consult notes/letters
• Advance Directives

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Scanning

• Document Imaging Management (DIM) System in your
  software
• Indexing of documents into electronic chart
• Scanners
• High-speed??
• Compatible with software (ask vendor)
• Physical workspace (scanner, computer, files for
  paper to be scanned)
• Staff training and dedicated time

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ScanningQuestions to Consider

• There will always be paper to manage so you will
  need a long-range plan
• Can you enter data into data fields while
  scanning (e.g., colonoscopy into health
  maintenance or diagnostic testing fields)?
• If normal, does it need to be scanned?
• Scanning service for large volume, or rent a
  high-speed scanner

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Pre-Loading (Data Entry)
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Pre-Load List--Prioritize

• Medication List
• Allergies
• Problem List
• Recent Labs
• Immunizations
• Last Vital Signs

• Health Maintenance (e.g., last pap, mammo, CR
  screen)
• Past Medical Hx
• Family Medical Hx
• Social Hx

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Pre-load considerations

• Have providers and nurses do some of the data
  entry
• Learn the system, increase speed
• Understand the work
• NoTCH 2-4 hours/week/provider or nurse dedicated
  to pre-loading
• Accuracy of data entry is crucialhave providers
  review and sign off before retiring chart

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Pre-load Considerations

• Work with your vendor to create a data-entry or
  pre-load template to streamline the process

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ProcessWhich Charts First?

• All Chartsstart from A, go to Z
• Only Active Charts (seen in last 1, 2, or 3
  years)
• Patients scheduled from go-live date forward
  (Recommended)
• Ongoing Patients being seen in next week or on
  next day

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ProcessWho does the work?

• Scanning skill level depends on process
• Less for scanning
• More for indexing and data entry

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ProcessWho does the work?

• Pre-Loading need some medical terminology
  background
• Provider
• Nurse
• Transcriptionist
• Medical Student
• Test the skill level!! Have them do some data
  entry and review it before beginning

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Retiring Charts

• How will you indicate when a chart is ready to be
  retired?
• Sticker
• Big Red X
• Also where in the electronic chart?
• Where will the retired charts go?
• Keep a run chart of how many are being retired on
  your wallcelebrate milestones

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Scanning Preload Take Home

• Providers Notice what things you are reviewing
  in the chart during a visit
• Office staff Think about the physical space and
  personnel you will need to accomplish the task

Im thinking
thinking
thinking
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Make a Plan

• Map out the flow of the paper chart
• Make a draft written plan/protocol with tools,
  and then test, test, test
• Revise your plan
• Continue testing and revising the plan to meet
  your needs and prevent getting bogged down
• Standardize the plan for all providers
  chartsmay take some negotiation

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Sample Tools
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