The role of the Health Information Manager is no easy task. Like a conductor leading an orchestra, they must lead a wide range of health information initiatives – across multiple departments – to keep their health system in tune. And with the healthcare data explosion – driven by the Electronic Medical Record, and clinical imaging – there is a huge imperative to manage increasingly diverse types of information.

So how can a Healthcare Information Manager keep up with their health systems’ adoption of the electronic medical record without missing a beat? A recent survey of over 200 health information managers from providers across North America by Iron Mountain sheds light on the areas of the transition to the electronic health record that are the most challenging. By recognising these challenges, health information managers can develop their own strategy for a painless Electronic Medical Record (EMR) transition – creating harmony with their clinicians and the patients they serve.

The survey revealed some interesting facts:
- Paper in Person- No matter how pervasive the EMR is becoming, paper-based patient records are part of the equation. 80% of the survey respondents are using paper charts in some, or all, parts of the health system.

These records must be properly stored, indexed and managed throughout the transition to the EMR, but that doesn’t mean they need to be kept onsite forever. While there may be a need to keep some active patient files close at hand, the remainder can move to a secure, offsite storage location. This strategy can help to repurpose space and increase efficiency – while enabling rapid access to needed records when required – and provides an overarching motivation towards true EMR user adoption.

- Document Imaging – Imaging patient records is also a critical part of supporting the transition to electronic records, and this activity can be a significant drain on resources. The survey revealed that 81% of the respondents are using either full time or part time employees to manage their scanning and battling to still keep up with the demand. Capturing patient records while they are still most useful is when the EMR benefits are most obvious.
- Secure Shredding – Managing the disposition of records at the end of their retention period is also an important part of the HIM function, but 58% of those surveyed don’t know what records are actually authorised for destruction. And as the risk of audits increases, health information managers need to develop sound retention and destruction policies that improve efficiency and enhance compliance.

According to the Iron Mountain survey, the main "pain points" are spread pretty evenly across the four primary challenges faced during the EMR transition: Knowing what to destroy (27%); Managing Compliance (26%); Scanning records (24%) and Managing paper-based patient records (23%).

In Australia and New Zealand the simple task of scanning as part of an EMR solution, is often a far larger problem than it first appears. The considerable backlog of historical records that will need to be scanned generally means that any EMR initiative not only has to deal with the complexities of day-forward scanning of currently active records, but also that of a much larger backlog. This can often mean that the expected scanning efforts and costs can easily double when considering the volumes and quality required for this historical scanning.

Within Healthcare, the intent to work smarter is indeed there and the benefits of EMR well understood, but the practicality, the sheer cost of implementing onsite scanning solutions and immediate relevancy of paper almost always outweighs the ability to become truly paperless.

“Scanning of records is often done internally at a significantly higher cost, when compared to an outside specialist, and then often only gets done at the time those records are put into long-term storage. Transition to an EMR only becomes practical when a more proactive approach to imaging is adopted, allowing current patient records to be captured while they are still relevant and being used, and one that converts the backlog of historical records to make them accessible electronically”, says Avron Welgemoed (National Solutions Manager at Iron Mountain).

Another part of the challenge is in dealing with changing a working culture based on paper where, along with the convenience of paper, comes easy duplication and with that even more confusion when trying to manage those multiple and duplicated paper records. This in turn drives the need to keep those often poorly managed records, close by so they can easily be searched for and acted upon.

The reality is that whatever new solutions are put in place, the major challenge to healthcare is that they will still need to deal with the historical paper records, essentially forcing a dual pronged strategy to exist at least for a number of years or long enough to digitise those historical records and go truly EMR.