Going Paperless – Getting Maximum Value While Avoiding the Pitfalls

Over the years, I’ve worked with many clients on projects to make the transition to electronic records by digitizing their paper records. The conversation often begins with the client’s excitement for finally putting an end to the long-term process of storing mountains of paper documents with a records management company and ending the exorbitant fees associated with storing, retrieving, delivering, and finally disposing of the documents. Digitizing is an admirable goal shared by many organizations that have come to realize how inefficient and expensive this process can be when managed incorrectly. Contrary to many assumptions, digitizing effectively involves much more than simply scanning your documents. You also need to properly archive, categorize and protect them so they can not only be found when needed, but protected against both internal and external threats. Additionally, you need to be able to effectively eliminate redundant, obsolete and trivial data – otherwise known as ROT – so you don’t waste time, effort and money scanning multiple duplicate records.

Avoiding and navigating these obstacles requires thorough planning, because digitizing documents without a strategy can often cause more harm than good.

I remember a walkthrough with a client who was very proud of their initiative to “go paperless.” The employees had begun using their multi-functional devices to scan their paper documents and store the digital images on a network drive. Unfortunately, they did not have any standards for what should actually be scanned, naming conventions for the digital files and file folder structures to store the digital files. They ended up with an ever-growing network drive and were unable to produce any of the documents they had scanned because they couldn’t retrieve them. Ultimately, the “go paperless” strategy was abandoned, and the management team was replaced.

This article discusses some of the lessons that can be learned from this and similar experiences.

The list below sets forth some very simple dos and don’ts to consider when embarking on the digitization journey.

Do’s

Leadership and Oversight

• Identify a champion, senior executive or manager who will be responsible for high-level guidance and planning to promote the success of the digitizing initiative. The role of the champion should include responsibilities such as strategy planning and guidance, high-level advocacy and finally, approving deliverables. Ideally, the champion should be supported by a project manager and steering committee who monitors the implementation team’s success, communicates project progress and ensures regular feedback from the diverse project team (which should include critical areas such as IT, Legal, Facilities and Finance).

Budgeting and Cost Management

• Create a budget. The cost of imaging a banker’s box of records, which can hold 2,000-2,500 pages, can range from $200-$300. This can be higher for certain types of non-standard records such as X-rays, MRI scans or sensitive patient files which may require specialized handling and collaboration among team members. Understanding the scope and expenses will allow the firm to develop a timeline and budget appropriately.
• Audit third-party storage expenses and storage contracts. Third-party storage companies typically arrange their storage contracts to guarantee and maximize their monthly revenue stream, often using excessive fees to disincentivize eliminating boxes that should be destroyed or digitized and creating “forced non-compliance.” Here is a typical example. Recently I worked with a client who faced storage exit fees that became so unreasonable they simply acquiesced to a “business as usual” strategy where they simply continued to pay the monthly storage fee for records that they did not need, versus the permanent-out fee that would have allowed them to destroy these records. I created a financial model for them that projected that they would spend nearly $390K just in storage fees over the next five years. Over ten years, the model showed the expense would increase to more than $880K on files they no longer needed, and which, in many cases (e.g., PHI), they were obligated to eliminate! The unfortunate reality is that many firms are experiencing a similar situation, and ignoring the reality will not only lead to additional expenses but significant legal and regulatory risks on both a state and federal level, especially when you consider the costs of litigation and the potential penalties for overstoring PHI. When creating a strategy for digitization, understanding the costs and risks involved in storing physical records is critical to developing a return on investment and risk-based analysis.

Legal and Compliance

• Review the records retention schedule to prioritize those record types considered to be vital (particularly important). Records that have a retention period greater than a 15-year or permanent retention requirement can be excellent candidates for digitization. Additionally, make sure your records retention schedule is up-to-date and that the retention periods described on that schedule are accurate, so that you avoid mis-prioritizing records. Other considerations for high-priority digitization include records that are accessed frequently, required to be accessed by geographically dispersed employees or that require access by multiple employees simultaneously.
• Consult with Legal or records management professionals. Depending on the jurisdiction, courts or agencies may require you to keep original documents or to store documents in a particular format. They can still be digitized, but you’ll also need to retain the physical records.

Records and Data Management, Security 

• Aggressively eliminate non-record materials (junk data) such as old marketing brochures and duplicate printouts of patient data. Reducing duplicate healthcare records not only improves data accuracy and patient care but also significantly cuts costs associated with storage, management and the potential risk of errors, ultimately streamlining both administrative and clinical workflows.
• Develop the search fields. These are the fields that can be searched to allow an individual employee to find a specific record. Spend time on understanding what fields of information that are currently used to search for a record. It’s advisable to have more than one search field for each record. The search fields will vary based on the type of documents, such as a medical record as opposed to a vendor invoice. Examples of search fields include patient name, medical record number, date of birth, address, document type (e.g. EKG, lab results, form number), invoice number, vendor name and invoice date.
• Determine where to store the electronic records. The digitized records need to be stored in a repository for easy access. Choosing the proper repository is also another reason to engage with an experienced, third-party imaging provider. The provider can often offer a repository solution or has the ability to make recommendations based on your use case. Repositories can include Enterprise Content Management (ECM) systems, SharePoint and EHR for medical records. Effective retention management in healthcare requires comprehensive metadata tagging including patient identifiers, document type, creation and service dates, retention period, access level, legal hold status and sensitivity classification, to ensure accurate categorization, compliance with retention policies and streamlined document lifecycle management.
• Ensure appropriate security. Sensitive information such as PHI must be secured whether in a physical or electronic format. Examples of required precautions include role-based access limitations, strong password protection, maintaining audit logs and ensuring firewall protection and disaster recovery procedures.

Third-Party Engagement

• Strongly consider using a third-party imaging provider with expertise in digitizing healthcare records. An experienced and skilled third-party imaging provider can provide critical advice throughout the digitization process, which will minimize the investment and lower the risk of non-compliance. As digitization has gained popularity, some providers have supplemented their service offerings with digitization solutions, but may not have developed the necessary experience and expertise to provide a complete solution. Ensure the provider has trained employees, production capabilities/capacity, quality procedures, security, ability to customize and post-scanning solutions.
• Evaluate the use of intelligent information management (IIM) tools. Effectively using the right suite of IIM technologies can enhance data accessibility, accuracy and compliance, empowering organizations to streamline workflows, improve patient outcomes and reduce administrative burdens by leveraging advanced automation and analytics.
• Consider utilizing external records management professionals. These professionals play a crucial role in the pre-scanning process by assessing document types, categorizing records based on retention schedules and identifying sensitive information that requires special handling. They also ensure that metadata tagging, indexing protocols and compliance standards are defined upfront, setting a strong foundation for efficient digitization and future accessibility.

Don’ts

• Take on too much too soon. Resist the temptation to rush the process. Start with something easy or a small project, create a replicable model, and build off the success. Under a controlled environment, valuable knowledge will be gained with each project.
• Digitize everything. Not only is it expensive, it’s rarely necessary and is often legally risky to overstore information that is either PHI or could be damaging in litigation. Once records are sent to a third-party storage provider, 98% of the boxes are never retrieved again and, once they are retrieved, are rarely retrieved under positive circumstances. Consider these alternatives:
  • Digitize on a go-forward Digitize any new paper records to eliminate or greatly reduce the number of boxes being sent off-site for storage.
  • Digitize the record only when it’s needed. When a box or file is retrieved from the third-party storage provider, digitize the records. There’s no need to digitize a record that’s already off-site in a box until it’s actually needed
  • A caveat to the point above. If the records that are stored off-site and are very active, consider digitizing the boxes that were sent off-site in the last year or two. It’s a hybrid approach to minimize cost and maximize the digital efficiencies.
• Digitize convenience copies. It’s not uncommon for employees to make multiple copies of the same document. There is no need to digitize each copy.
• Digitize records with short retention periods. As mentioned earlier, digitizing records incurs an expense. It may be prudent to maintain records with short retention requirements in a physical state rather than digitizing them.
• Get discouraged. There will be challenges during the digitization journey. Again, the third-party imaging provider is a valuable resource for minimizing them. Include the provider in your strategy sessions; their advice could minimize the challenges.

The benefits of a digitization strategy can reduce costs and storage space while providing greater access to records and improving collaboration, security and customer service. Making the decision to digitize records requires a commitment from the organization and a strategy for execution. Including the third-party imaging provider in the strategy discussions offers the ability to benefit from their experience working with other clients and will not only provide valuable guidance but will help you avoid many of the pitfalls. Making the decision to digitize records is often the most difficult, but once made, the journey will produce benefits throughout the organization.

Let Konica Minolta help get you started on your digitization journey. Learn more here.