New Orleans — Because patient medical records must be stored for years and, in some cases, indefinitely, cosmetic surgeons should consider computer storage and scanning hardware and software, now less costly than paper storage, according to Stanford I. Lamberg, M.D., associate professor of dermatology, Johns Hopkins Hospital, and in private practice in Baltimore.
"Scanning records is particularly beneficial for dermatology as a specialty because there are often years between the patient's visits," Dr. Lamberg explains.
"Patients come in only when they have a problem. They often do not remember which treatments they received and how successful these treatments were. You need the patient's record for that information."Electronic record storage methods are easy to implement. Such storage also makes it easier to retrieve files.
"Retrieval and file space for paper records is costly," says Dr. Lamberg, who designed his scanning software to get out from under the mountain of records accumulating in his office and basement.
Smart scanning "Scanning records saves space, staff time and money," Dr. Lamberg explains.
Most states require that adult patients' records be retained for five to 10 years. A common misconception is that Medicare requires seven years.
"Medicare's seven years guideline has nothing to do with medical-legal aspects of the record," he says. "They say only that Medicare won't come back at you after seven years to collect money on a wrong coding or billing issue. However, the time limit does not apply if Medicare suspects fraud.
"The only reason Medicare would come back to you at all would be that they think you have been systematically upcoding. Once they say 'fraud,' there is no time limit.
"According to the GE Medical Protective, the largest U.S. medical malpractice carrier, 10 percent of lawsuits filed against physicians in all medical specialties are not brought until five years or more after the incident. This liability exposure leads malpractice insurance carriers to advise physicians to keep records as long as possible, even indefinitely, as insurers find it easier to defend the physician if a record is available than to contend with the physician's and patient's memories," Dr. Lamberg explains.
Additionally, there is no statute of limitations regarding administrative actions by state licensing boards, which may require a physician to respond to a complaint many years after an incident.
Paper charts "Many physicians give expensive office floor space to storing thousands of charts that haven't been pulled for years," Dr. Lambert says.
When inactive charts are needed, office staff must leave the front desk to search the back office. Often, they realize only after a time-consuming office search that the record is stored offsite.
Scanning records Dr. Lamberg points out that paper storage problems, such as demands on space and time, can be eliminated if the charts are transferred to digital media by scanning them into a computer.
"Scanning and saving to the computer is particularly valid if your state allows the paper copies to be destroyed. Most states now allow the medical record to be stored on any media, including computer images. Check with your state medical society and malpractice carrier to see if such laws apply to your paper records," he says. "Scanning has become practical in the last several years, thanks to inexpensive, high-capacity hard drives and inexpensive, fast scanners equipped with automatic document feeders."
The initial scanning of records may seem daunting. However, available hardware and software make the process so easy, a high school student can scan thousands of records in a few weeks during the summer, Dr. Lamberg asserts. Scanning inactive records does add to the cost of the scanner and software.
"It takes only three months to recover the costs of scanning compared to paper storage," he says.
Adequate hardware, including computers, scanners and backup devices, is relatively inexpensive. Hard drive space today is not a limiting factor, as it was a few years ago.