Paper Records: Is it Time to Let Them Go?

Vol. 14 •Issue 11 • Page 16
Paper Records: Is it Time to Let Them Go?

It’s no surprise that health care facilities, especially the health information management (HIM) department, have an overload of paper records. And it’s no surprise that many professionals are quite confused as to what should be done with them. But what is surprising is the reluctance found in parting with the paper record.

Accepting change and evolving with a growing technological society in reference to the electronic health record (EHR) has been all the buzz, but what about the “pack rat” that lives deep inside health care professionals? It’s not just getting used to an EHR—it’s attempting to let paper records go.

Recently, President Bush announced the Health Information Technology Plan, stating, “Within 10 years, every American must have a personal electronic medical record.” And he emphasized the importance for setting the standards of an EHR in hopes of a more organized health care system, enhanced privacy and safety, and money saved.

With all the effort put forth to implement an EHR system, where are we in the effort to dismiss the paper record?

Unfortunately, there is a lot of apprehension to let paper go. It is a comfort to know that the original record is still available, but is this comfort hurting us?

The Bottom Line

The fact is the decision to maintain or destroy medical paper records isn’t really up to the health care facility. It’s the state’s decision. Because retention of medical records is a state governed function, it depends on what a specific state has declared as the legal record.

Every state has a medical record retention law. For example, New Jersey’s state law declares a 10-year retention period for adult records, and Kentucky’s state law declares a seven-year retention period.

“If we hang on to paper, people will continue to use it. A copy of the record will be printed, something important will be written on it and then you have another set of records starting,” explained Jill Burrington-Brown, professional practice manager, American Health Information Management Association (AHIMA). “It defeats the purpose of bringing all the patient information into one place; into one record. The state laws need to realize this.”

John Quinn, principal, Capgemini Health, pointed out, “In the United States, 99.9 percent of physicians use computers for patient visit history based on getting reimbursed. Retaining the records today is more about keeping the evidence for reimbursement and continuum of care.”

Quinn explained that if there was a law suit and medical records were subpoenaed, the evidence of care on the paper record and the diagnoses need to be available—because right now, the paper record is considered the legal document by the state.

Cecilia Hilerio, RHIT, assistant director, health information management, Saint Barnabas Health Care System (SBHCS), Toms River, NJ, explained her facility’s policy. “We use a document management system and scan our records into an eWebHealth system, which is very easy to use. We also maintain the paper record and store it offsite.

“We see this policy as a backup if the system was to ever fail, and it does address the HIPAA security aspect as well, in that we can always be certain we can provide that paper medical record for a continuum of care, because New Jersey doesn’t recognize the EHR as a legal record.”

And so, the health care industry not only has to convince its professionals to accept the possibility of a paperless system, all 50 states need to get on the same page as well.

Where We Are Now

“My experience is facilities attempt to retain the document in spite of the local/state laws that might give them some flexibility in their retention,” stated Matt Rohs, vice president of operation, Smart Document Solutions.

Most states haven’t defined that an EHR could replace a paper record, mostly because the patient’s and/or physician’s actual signature is still needed.

That’s what Robert M. Summers, systems analyst for University Hospital in Louisville, KY, feels is the corruption in this issue. “Until there’s some kind of international standard that’s accepted as a digital signature, paper will never go away.”

Summers is one of the few who has actually started shredding admission records, but still has to file the patient’s signature and the physician’s signature as a paper record.

Rohs mentioned one facility he works with that is 100 percent electronic, yet their retention policy is to retain everything. He mentioned another facility that retains everything and also has a system called deep storage. “It’s a storage area on the facility’s campus, but not in the medical records department,” Rohs explained.

“Right now, in New Jersey, the acceptable business document is paper or microfilm. So if we’re already accepting microfilm, we should be moving toward accepting electronic records,” explained Tim Keough, divisional director of HIM and compliance, SBHCS.

Keough added that there is a need for the electronic record nationwide because of HIPAA and President Bush’s latest initiative, and each state should be accepting an EHR as a legal document.

But for now, SBHCS stores most of its paper records with an offsite third-party company.

“New Jersey hospitals have to keep adult paper medical records for 10 years past the last service. And our facility can only keep one year of medical records onsite, so when records from two years ago are needed for audits we need to retrieve them from offsite, and this is an expense,” Keough stated.

Space Is Money

“Space is as expensive as an EHR system these days. It really depends on what kind of space you want to pay for. If you want to keep paper records longer, it’s going to cost you. It’s probably cheaper in the long run to store the records electronically,” offered Burrington-Brown.

Offsite storage companies tend to make it extremely affordable to send the records offsite, but the cost becomes an issue when a facility wants to retrieve its records.

“When we need to retrieve a record we have to wait a day and pay almost $30 to get each record. That’s a lot of time and money for a facility with about 37,000 discharges a year,” Keough stated.

And Rohs considers the cost of transferring all of the documents out of offsite storage the bigger issue. “The problem is if you ever want to take all your medical records back to store them onsite, scan them or use a different company, then apparently it becomes very cumbersome from a financial stand point.

“I don’t have first hand experience with the specifics, but some facilities build up so much storage over a number of years that it’s cheaper for them to stay with that company than extract the records all at once,” Rohs stated.

Unfortunately, “within the state of New Jersey, and many other states, there is no alternative to storing records,” Keough added.

But there are a number of different variations to storing the paper record. It can be stored onsite either in the HIM department or on the property, or there are offsite companies that will store and index the records. Some facilities convert them to microfilm because it’s an inexpensive way to take up less space. And some facilities have started to scan the records and actually shred some of the paper.

Summers’ facility has started this process. “Once the admission paper record is scanned into Information Management Research’s Alchemy software, it goes into a shred bin. We have two different companies for shredding, one’s onsite and the other is offsite. We get a report back from the offsite company stating what they’ve shredded, how many pounds and a legal document stating that they actually did shred the documents.”

Although they can’t shred the medical paper record they’ve scanned into the electronic system because of Kentucky’s retention law, at least they’re going in the right direction, and that’s what Quinn feels is so important. “If a facility has scanned all its medical records and is storing them electronically, not necessarily an EHR, that’s a huge step! It’s important to understand that middle ground.”

Summers agrees and raved about his current experience with the Alchemy software. “The thing that’s great about this software is that the way most people file can be mimicked. We have a database and we can create folders within it, so we can just name the folders: file cabinet number one, etc.”

So digital imaging is an important middle ground to strive toward.

“Facilities need to stop using microfiche or microfilm. At the very least, digital imaging must be looked at as a solution, if it’s ever going to move into a fully electronic environment,” assured Brian Mizell, director of information storage at Smart Document Solutions.

Hope for the Future

Burrington-Brown mentioned the steps needed to get to the President’s goal in 10 years. “After you take care of the legalities—whether or not an EHR is legal as the original document in your state—the next thing a facility should do is think about what the paper record is used for and how long it should be maintained.”

If a facility decides to retain the records longer than the state law requires, it may have to do with what’s more useful for the organization, explained Burrington-Brown. “The other things that factor in are of course what the facility has room for and how much it is willing to pay,” she added.

For everyone to have an EHR in 10 years, the current issues have to be dealt with. “We need standards for interoperability and the people who don’t use them will be out of business; our economic system will take care of that,” she stated.

And HIM professionals can get involved. Keough mentioned that he’s addressing the issue of what’s considered a legal record in New Jersey at the next component state association (CSA) meeting in Trenton this month. And every state has a CSA.

Tricia Cassidy is an assistant editor at ADVANCE.

Find the Best Fit for Your Facility

If storage space or document management is what your facility needs to start implementing an EHR system, take a look at these companies and find the best fit.

•Iron Mountain at

Since 1951, Iron Mountain has helped store and manage paper records.

• Recall Corp. at

Recall supports the total life cycle of your organization’s document work flow, providing offsite management and secure retention of all types of information assets.

• Cardone Record Services Inc. at

CRS was founded to provide programs and services for the management and protection of medical records. Off-site record storage is an integral part of the services provided to customers. CRS provides quality customer service along with accurate record storage and retrieval.

•Midwest Medical Records Association Inc. at

MMRA provides an array of release of information services. These services come in partial or full-service packages. Each package is designed specifically for the needs of the HIM department.

• EDCO at

More than 90 percent of EDCO’s business is preserving health information. EDCO understands how other HIM departments work. They take the time to learn all about the departments, condition of records, needs and goals before making recommendations.

• Nauvalis Healthcare Solutions at

Nauvalis Healthcare Solutions is a dynamic provider of information management services to the health care community. Founded in 1989, Nauvalis is recognized as an excellent provider of document imaging and storage solutions.