Q: I'm afraid of the conversion to electronic records. How do I get my old charts into the EHR?

A: The short answer is scanning and typing. The long answer depends on how often you'll need those old paper charts in the future.

"If you're an orthopedic surgeon, you have charts for lots of patients you'll never see again or may see just one more time, so why bother converting them to the EHR?" says Nelson. "But you may frequently return to a chart for a carpal tunnel patient. That chart would be worth changing over.

"Because of their ongoing relationships with patients, primary care doctors are looking at a wholesale conversion of old records. One method is a daily, piecemeal routine—pulling the charts of all patients who have an appointment two weeks from today. Then you set up their electronic charts.

"What should you transfer into the EHR? You could scan the entire paper chart and store it as a folder of PDF files. Or, you could fill the EHR with core information—the problem list, the medication list, a baseline ECG, the most recent history and physical, the last progress note, and the most recent lab results. Some of this you could scan, but a medical assistant could probably type in the medication list and lab values just as quickly. And it would be a good learning experience.

"Another approach is to convert all your old charts to the EHR in one fell swoop, going from A to Z. This makes sense if you're in a hurry to convert a file room into an exam room, or have some other compelling reason to get everything done at once.

"Some EHR programs have embedded tools for scanning paper and managing those files, while others are designed to interface with add-on scanning programs. Ask your EHR vendor how it accommodates scanning, and how other customers have managed the process."