Best Practices for Transitioning from Paper Charts to PCC EHR

PCC has assisted many practices during their transition from charting on paper to charting in an Electronic Health Record (EHR). This article lays out the options and processes involved to help your practice make important decisions about transitioning from paper charting to using PCC EHR.

Choose a Method

There are three main methods for transitioning from paper charts to PCC EHR. Each of the three methods has pros and cons, and each uses some version of the steps listed in this article. Your practice can pick the method that is right for you.

No Scanning

In the No Scanning method, the practice does not scan any paper charts, and instead manually enters essential chart elements and historical information, such as growth points and problem lists, into PCC EHR. The practice uses the paper charts for reference at each of the patients’ next few visits, then stores the paper charts and continues all charting in PCC EHR. Chart status is tracked on both the paper chart and the EHR, as described below.

If you decide not to scan any parts of your paper charts, consider the following:

  • Extended Time on Paper: The practice will not be fully paperless until patients with paper charts have aged out and enough time has passed that the chart can be shredded.

  • More Data Entry: Complex cases may require in-depth data entry or continued paper chart reference.

Hybrid Scanning

The Hybrid Scanning method requires providers to determine the essential chart elements that need to be scanned. These essential chart elements are marked using an agreed-upon method such as those described below. Once marked, any staff member can scan or manually enter only the elements marked by the providers. The practice uses the paper charts for reference at each of the patients’ next few visits, then stores the paper charts and continues all charting in PCC EHR. Chart status is tracked on both the paper chart and the EHR, as described below.

If you decide to scan only parts of your paper charts, consider the following:

  • Reference Paper Charts Less Frequently: Electronic charts contain all the essential historical chart elements so the practice does not need to reference the paper charts as frequently.

  • Some Data Entry: Complex cases may require in-depth data entry or continued paper chart reference.

Complete-Chart Scanning

In the Complete-Chart Scanning method, the practice scans all of the charts and enters them as documents in PCC EHR. The practice manually enters historical data into the chart as needed.

If you decide to scan all parts of your paper charts, consider the following:

  • Time Spent Scanning: The scanning effort is time-consuming.

  • Scanner Requirements: Office scanners may fail with heavy use, and professional scanner rentals can be expensive.

  • Large Documents in the Patient Chart: Depending on the way the chart documents are imported, this method can result in very large documents in the patient’s chart.

  • Third Party Document Categorization: There are scanning companies that will work with your practice to break the chart into pieces so that scanned documents are categorized and not lumped into one large document. The cost for this chart breakdown can be significant.

  • Achieve Paperless Charting Faster: Once everything is scanned, the paper charts can be shredded.

Prepare Paper Charts

PCC recommends that practices prepare their paper charts in a consistent manner so that, once prepared, paper charts can be scanned by any staff member.

Identify the Essential Elements of the Chart

PCC recommends that providers look through patient charts to identify which elements are essential and should be entered manually, included in a partial-chart scan. Similarly, providers will want to consider where to break up full-chart scans.

Commonly identified essential chart elements are growth points, visits, vaccines (if there is no bidirectional immunizations interface), problem list, facesheet, and insurance card image.

Mark the Essential Elements of the Chart

PCC recommends that all staff use an agreed-upon system to mark the essential chart elements or document breaks for scanning.

Some practices identify the essential chart elements by inserting a unique color of paper (e.g., green paper marks the growth chart) before each essential element of the chart. This way any staff member can know which elements they need to scan and how to sort them. Often, practices use a visual aid such as a folder grid to determine which documents to scan and where to file the scanned documents.

Scan and Import Paper Charts

PCC recommends that the essential elements of the chart are scanned separately or split up after scanning so that they can each be linked to a specific document category.

It is helpful to determine who at your office will scan charts, who will link them, and when. At some practices, one staff member scans the charts, and one staff member links the documents to the chart. At others, any staff member can scan and link documents.

You can set document categories in PCC EHR’s Document Configuration. If you keep track of which documents go in each category, you can select the corresponding category when importing chart documents.

Once all essential elements or all chart pages are scanned, remove the “Paper Chart” patient flag from patients in PCC EHR. (See the track Chart Status in PCC EHR section below for details.)

If a practice wishes to scan charts prior to going live, PCC recommends that they create one folder per patient, with subfolders named to match the document categories that they will have in PCC EHR.

In the example below for John Canning, the ConsultReports, Emergency, Labs, Pre-Check-In, and Visits folders are all names of document categories in PCC EHR.

Manually Enter Essential Data in PCC EHR

Growth points, problem list items and other data can be entered in PCC EHR to display trends in the patient’s electronic growth chart and in the patient portal, as well as key clinical data.

PCC recommends that practices manually enter at least two historical growth points for older patients, and all growth points for younger patients.

PCC recommends that providers or clinical staff enter problem notes and other clinical information, as they are more likely to catch typos.

If the practice’s state does not have bidirectional immunization integration, PCC can use billing charge data during the practice management conversion to determine historical immunization administration. The practice should always check converted immunizations against the paper chart after a conversion.

Track Chart Status on the Paper Chart

Practices using the no-scan or hybrid-scan methods will continue to use paper charts for reference until there is sufficient clinical information in PCC EHR, or until all essential chart elements are scanned in.

PCC recommends the following workflow for tracking chart status on the paper chart.

  1. Stamp the front of the paper chart with the words “Sick” and “Well”.
  2. For each sick visit that the patient has after charting moves to PCC EHR, put a checkmark beside the “Sick” stamp.
  3. For each well visit that the patient has after charting moves to PCC EHR, put a checkmark beside the “Well” stamp.
  4. After one well visit and two or three sick visits, stop pulling the paper chart for reference.
  5. Complex cases may need more checks before the practice stops pulling the chart. Some practices keep the paper chart(s) of complex cases active. Alternatively, they may scan or manually enter the complete chart.
  6. For all Scanning methods: After the chart is scanned, stamp the front of the chart with the word “Scanned”.
  7. When new papers and documents come in for the patient, check the paper chart for the “Scanned” stamp.
  8. If the stamp is present, scan the new document into the electronic chart. Do not add new papers to a scanned paper chart.

Track Chart Status in PCC EHR

Practices transitioning from paper charting will benefit from tracking which charts are scanned in PCC EHR.

PCC recommends the following workflow for tracking chart status in PCC EHR.

  1. Prior to going live with PCC EHR, mark all patients with the “Paper Chart” patient flag in PCC EHR.
  2. When the chart is fully scanned in, or when all essential chart elements are scanned in, remove the “Paper Chart” flag.
  3. Run a Patient List report for all active patients with the “Paper Chart” flag to track the status of paper charts at the practice and find charts that need to be scanned.
  4. Practices may choose to use custom fields in Patient Demographics to indicate further details about scanning and status of the chart, but these fields are not reportable.
  5. Reach out to PCC for assistance as needed. We look forward to hearing from you.

  • Last modified: December 2, 2024