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Less than half of 1 percent of all U.S. hospitals currently have a complete electronic health record (EHR) system, according to the latest statistics from the Healthcare Information and Management Systems Society (HIMSS). But, momentum is building as hospitals, healthcare systems and doctors' offices begin more rapid installation, integration and enhancement of EHR systems to demonstrate "meaningful use" and capitalize on federal incentives.

But as they expand the use of EHR systems, healthcare providers must have a clear understanding about how to integrate a patient's historical paper-based records, as well as a myriad of other types of electronic documents, effectively into their databases. We explore the top 5 considerations for organizations developing a comprehensive EHR system.

Advantages of EHR
Evolving from a paper-based records system to an electronic one offers a number of benefits for healthcare providers and patients alike. Patient files are more easily accessible from any where and can be quickly located when needed, supporting greater and simpler collaboration between treating physicians. From a single system, physicians can get a complete picture of a patient's medical history, including results from lab reports, prescriptions being taken and other information that would be helpful in making an accurate diagnosis. In addition, there are numerous benefits to the providers themselves. Filing and other human errors are dramatically reduced, layers of security are added by being able to have back-up copies in a variety of electronic media, and storage space and costs are minimized when compared to paper files.

To successfully integrate paper and electronic documents into a healthy EHR system, a healthcare provider must:

1. Overcome the challenges of integrating paper-based records into EHR systems. One of the biggest hurdles for moving into the EHR world is a phobia of a fully electronic world. Doctors are familiar and comfortable with straddling the world of paper-based records -- such as patient files in their office -- and electronic documents, including lab and x-ray reports. And each of these methods offer distinct benefits for the user. For example, doctors may find it easier to write case notes on the paper files while treating a patient than entering information into an EHR.

Finding the right solution for scanning, compressing and indexing paper-based records can alleviate many of the initial concerns. The right solution should help automate patient identification on each record, support color capture so that hand-written notes on paper files can be easily discerned, enable full search ability to improve access to information, and allow for adequate compression so electronic files do not take up inordinate amounts of digital storage space and are easy to transfer via e-mail for collaboration purposes.

2. Establish which key elements should be included in every electronic record. After deciding to use an EHR system, a healthcare provider must determine what elements are necessities for its practice and the usability of the electronic files. For example, scanned paper files will need to have a good image quality and be saved in full color, so doctors' handwritten notes are legible.

3. Determine how to effectively apply standards to ensure long-term accessibility of medical records. Another consideration is the length of time the records must be accessible. If these records must be accessible for several decades -- the life of the patient, for instance -- a provider should consider saving electronic records in a standards-based format for archiving, such as PDF/A, so there will be no concerns about reading the files in years to come as software and devices evolve. These standards also can help healthcare providers ensure their systems remain compliant with HIPAA and other regulations.

4. Uncover ways to improve the usability of electronic documents. A healthcare provider should consider the best means for compressing their files, because if not done properly, each record could be extremely large and introduce difficulties in storing and accessing data. Additionally, full text search capabilities are vital for enabling users to quickly find needed information or associated documents.

5. Explore what production environment best meets individual needs for capturing paper-based and born digital medical records. Healthcare providers should look for a document conversion platform that is capable of handling a variety of documents -- from scanned paper, e-mails, electronic data streams from labs, just to name a few -- and build an intelligent workflow that enables all sorts of paper and electronic documents to easily be integrated into the EHR system.

In many instances, the complexity of document conversion systems is the major roadblock for healthcare providers moving to a fully electronic medical records system. What to do with the paper records, and how to integrate them with existing electronic files, can often be an overwhelming prospect. By determining the best processes for scanning and compressing paper documents, developing an effective document production environment and defining the key elements and standards for file format, healthcare providers can benefit greatly from EHR systems.