SOA Long and Thanks For All The Fiche

What’s the best approach for transitioning from physical records (paper and microfiche) to digital records for your organization? Should you just rip the bandage off and have it done all at once? Or should you build capacity into your systems, in Service-Oriented Architecture (SOA) fashion, to transition incrementally, over a longer period of time?

Like the dolphins that left planet Earth – just in time – in the fourth book of the Hitchhiker’s Guide to the Galaxy series, the time has come for healthcare organizations to move away from physical and enter the digital records galaxy. But switching to computers from physical records is scary, and if not done properly, can be downright miserable.

When considering any legacy system upgrade – in this case the physical records are the legacy system – the criteria to weigh include cost, value, compliance needs, and of course risk assessment. Some organizations have both resources and business drivers that allow for (or necessitate) a one-shot project, while others need to consider an incremental implementation, biting off small pieces at a time.

Do-It-Now Drivers

  1. Your budget allows for a large, one-time outlay of funds.
  2. Your risk exposure during timeline (compliance, legal, etc.) for implementation is low. Your physical files are highly organized and properly stored, your filing index is well documented and the likelihood of translational errors is low.
  3. You have a mature IT infrastructure that can accommodate the upgrade. This includes an expansive digital vault for storage, disaster recovery, and compliance with governmental and legal standards – as well as ongoing systems operations and maintenance.
  4. Medicare/Medicaid business is a primary driver and you want to take advantage of Medicare and Medicaid EHR Incentive Programs.
  5. Medicare/Medicaid business is a primary driver and you don’t want to incur penalties for NOT meeting Meaningful Use criteria and deadlines.
  6. You’re planning to sell your practice and getting your records digitized will add value. For instance, there might be very valuable data already in the records that can be used for research purposes.

Once a do-it-now approach has been green-lighted, the implementation is relatively straightforward (as technology projects go) – though not without significant risk factors. While the per-record cost from a transcription vendor will be low, your initial outlay will be high, and you may not see a return on that for quite some time.

Additionally, because it’s a one-time push, there is a greater possibility that a translational error – unnoticed until the project is completed – could cause catastrophic results.

Do-It-Over-Time Drivers

  1. Your budget won’t allow for a one-time outlay and you need to align with cyclical budget constraints.
  2. Your risk exposure (compliance, legal, etc.) during timeline for implementation is high. Your physical files work for you, but an outsider likely would be confused, making proper translation of information more complicated. The process will require close internal monitoring along the way.
  3. Your IT infrastructure does not have capacity to accommodate such a significant system upgrade, and you want evolve your systems by building internal capability to digitize on an as-needed, and ongoing basis.
  4. A big bang fail, which could result from translational errors, would be catastrophic, and recovery would be very difficult.

If you don’t have drivers that make you have to do it NOW, then you can proceed incrementally, as budget allows. Using an SOA approach, you can establish a service within your enterprise that creates an internal capability to set up and manage your digital library, to include disaster recovery and compliance with governmental and legal standards.

Instead of saying, “Hey you, transcribers, please enter a few records at a time, at a very high per-record cost, into the system”; you would build a service that creates a capability to control this yourselves.  A HIPAA compliant, cloud-based service will allow your digital record vault to grow as your number of records grows – on an as-needed basis.

If you have a certain amount of allocated budget for translation in any given month – then you can prioritize your translation by client, or by when that record will next occur, or in any manner that aligns with your needs. This also allows you to control your risks more easily: if there is an error, it can be discovered and corrected in a timely fashion, mitigating potential for a catastrophic error. And the process will, over time, become more efficient.

The incremental strategy is generally safer and more realistic for many budgets – with the downside being that over time, you’ll likely spend more on the translation project itself. The benefits however are more easily quantifiable: you control the destiny of your records, the declining physical storage costs will eventually offset the translation expenses, and your risk of wasted or unforeseen money spent on this project is minimal.

Today’s reality for healthcare organizations is that laws and de facto compliances based on rules of discovery can require you to maintain both digital and physical copies of the records. But once you have a digital copy of the record, you start to meet new compliance criteria, you create opportunities to leverage the data in your records, and your physical maintenance costs will decline over time.

Switching to computers from physical records is intimidating.  But once the switch is done – if done correctly – it will have you singing its praises, or at least making fewer disparaging comments.

If you need help with a strategy to get your records digitized, and want to say so long to the paper and the fiche, contact us and we’ll help you get started.


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