Scanning FAQ

How do we know if our practice should scan our charts?
o There is no easy answer for this. If your providers will look at the scanned pages then it may
well be worth the effort. If you know your providers have no interest in reviewing old, scanned
documents, then it may not be worth the expenditure of time, money, and effort. This is a
decision to be made by each practice based on the needs and desires of their providers.
o Talk to other practices that have scanning projects. Ask them about their experiences and learn
from the challenges they have faced.

In what order should we scan our charts? And how long will it take?
o Scanning by appointment – scanning two or three days out from upcoming visits is generally
best practice. This allows a natural prioritization of active charts and guarantees that once the
providers have gone live, all the information they want will already be present in the chart.
o Scanning based on diagnosis codes – this may be a reasonable option if your first priority is to
make sure that, for example, all your diabetes patients are scanned first.
o Scanning alphabetically – we’ve heard reports of these attempts failing miserably, with sites
reaching the Ds only after several years, and finally abandoning their scanning project.
o How many charts do you plan to scan? ______ How many minutes (on average) will it take to
scan a chart? ______ Multiply the number of charts by the number of minutes, then divide by
60 to find the number of staff hours it will take to scan your charts: ______________
Tips and Tricks
 If you choose to scan by diagnosis code, be aware that this may mean a period where each
day may require switching back and forth between paper and electronic records.
 Whatever order you choose, begin scanning as far in advance as possible – if scanning by
appointment, at least a month in advance.

How much volume can I expect from my scanning staff each day?
o This will vary based on factors such as the speed of your scanners (the machines; pages per
minute) and the average size and complexity of your charts.
o Example: using a 65 PPM (pages per minute) scanner allowed scanning staff at one practice to
scan 30-40 charts per day or around 400 loose papers.
Tips and Tricks
 If charts are messy, or if scanners (the machines) handle a small number of pages per
minute, allow for more time per chart.
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
What kind of scanner do we need?
o Check with your EHR vendor to see if they have recommendations. Better to get a scanner
known to work with the software.
o How many scanners will we need?
 One scanning workstation (scanner, computer, space to stack and break down charts)
for each member of scanning staff
 If scanners and workspace are an issue, consider having two shifts of scanners each day.
o If desired, make sure the scanner:
 Does double-sided (called “duplex”) scanning
 Accepts other page sizes (e.g. legal size)
 Scans in color, grayscale, and black and white
 Handles a satisfactory number of pages per minute (PPM)

Besides a scanner, what other equipment will our scanning staff need?
o Stamp or stickers that read “SCANNED” to mark completed charts
o Staple remover, scissors, tape, hole punch/two-hole punch for breaking down and reassembling
charts
Tips and Tricks
 If you aren’t sure what papers the providers want to have scanned, give them a stamp with
the word “scan”. They can indicate which loose papers are important to them and send the
papers to a “loose papers to scan” bin.
 Providers and scanners alike can use their stamps either on the front of the back of pages.
 If you are worried about the time it will take to stamp all those pages, it is an easy habit to
build into the scanning process and is much faster than having to double-check in the EHR
when questions arise concerning whether or not a paper has already gotten scanned.
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Scanning Considerations

Scanning Staff
o How will this affect current medical records staff? As the need for their job decreases, can they
become scanners? There is a definite advantage in using those who are already familiar with
your chart layout, documents, and forms to scan items into the EHR.
o Will anyone besides the scanning staff have the ability to scan (receptionists, secretaries)?
o An alternative option is to hire an external scanning company. This often requires moving your
charts off-site to their facility and back. This may work well for an initial push, but not for
keeping up with loose papers from day to day.
Tips and Tricks
 Number of scanning staff members should be based on appointment volume. For example,
if 6 providers see a combined average of 80 patients per day, and a scanner can scan 35-45
charts per day, two scanners would be needed.
 If scanning by appointment, chart volume will eventually decrease as patients whose
records have already been scanned return for follow up visits. Over the course of several
years, need for scanning staff is likely to decrease.

Scanning Process
o Who brings the charts to the scanners? Who brings papers?
o How soon after a document arrives do you want to be able to view it in the EHR? How will you
create a workflow that allows this to happen?
o What happens to scanned charts? Back on shelf? Storage?
o What happens to scanned papers? Into charts? Into shredder?
o If a chart is marked as scanned, how will you know whether or not more papers have been
added to it since it was last scanned? Or how will you keep new papers from being placed into
already scanned charts?
o Does the system handle only individual entries on patients one at a time, or does it do batch
scanning? (Batch scanning: scan in a stack of papers in the same category, like labs, then sort
through the digital pages and assign them to the correct patient file.)
Tips and Tricks
 Allow scanning staff members to work individually at their own pace. Assembly line
methods are not ideal in this situation.
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
Scanned Content
o How far back into the paper chart will you scan? Go-live date, one year ago, two years, more?
o What items in the paper chart must be scanned?
o What items in the paper chart should not be scanned? (e.g. Rx refills, CMNs)
o Who makes the final decision on what will and will not get scanned?
o Will the scanning staff be responsible for any preloading/manual data entry as well?
o Who will do quality control of scanned content?
Tips and Tricks
 Commonly scanned items: Visit notes, labs, hospital discharge summaries, consent forms,
correspondence, results from mammogram, EKG, X-rays/MRI/CT, colonoscopy screening
 Preload rather than scan: medications, allergies, immunizations, problem list, medical and
family history

Organization of Scanned Content in EHR
o Who decides how scanned content will appear in the EHR?
o Who creates the categories for indexing scanned documents? How detailed will they be? (Will
each X-ray be labeled simply “X-ray” or will the label be more specific – “X-ray – foot”?
o Will the electronic chart replicate the paper chart’s tabs or not?
o How will scanned entries be organized—for example, will all X-rays go into a single file with
each new X-ray that comes in being appended to the top and the date updated to its date, or
will each X-ray from each separate date be its own entry?

Other Scanning Considerations
o What will come in through another interface and therefore not need to be scanned? (e.g. labs
from hospital lab interfaces)
o Where will scanned documents live? Server space requirements? Backups?
o Scanned documents are saved as images (often PDF files) and as such, cannot be mined or used
when generating reports. Preload any information you wish to see appear in reports.
o Scan and keep all HIPAA and consent forms.
o Consider installing electronic signature pads to reduce both paper usage and scanning
workload.
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