Many medical offices are transferring their paper charts to electronic medical records (EMR), which requires either employing the services of an electronic data-conversion company or purchasing equipment that will scan paper files into digital ones.
Replacing money-eating space with revenue-producing space is just good business sense, especially when you consider what that space is costing you. Or, if you can’t replace chart space with clinical space, it’s still worthwhile to find another use for it, rather than just letting it sit empty or gather boxes of junk.
“Nationwide, the average cost to rent medical office space is $24 per square foot annually,” says Scott Ferguson, CEO of Birmingham, Ala.-based ChartCapture, which sells machines that convert paper files to EMR. “If a chart room is 300 square feet, at $24 per square foot, that’s over $7,000 a year, every year, year after year to store this paper. On the flip side, if you turned that chart room into one or more exam rooms, you could be talking about an additional $100,000 or more in revenue per year.”
EMR systems are affecting the design of medical offices as practices catch up with the electronic age. Everything—from finding a home for the electronic cooling system to allowing a doctor to use EMR and communicate with his patient face-to-face—is being considered in new office design. And, as chart space in nursing stations decreases, the look and feel of these stations will also change, becoming more patient-friendly and less intimidating.
Location also matters
Most physicians and practice managers would opt to turn a former chart room into an exam or procedure room. But the location of your medical records will determine what to do with any space that becomes freed up after an EMR transition.
In many practices, medical records are kept in or near the front office, which often means the space can’t logistically be converted to clinical space such as an exam or procedure room. As long as the chart room is adjacent to a clinical corridor or has access to a hallway, it can be modified. “Or they can use the space for ancillary medical purposes such as an x-ray area,” says Todd Cohen, a partner at CK-Construction Management in Atlanta.
But, if an x-ray area is your first choice, it’s likely that your whole practice is expanding, and you should probably consider a new, bigger office instead, according to Cohen.
If your medical records are kept in a chart room that’s located within clinical space, in the back of the office, or in a storage or conference room, converting the former chart space to a new exam or procedure room is a good choice, according to experts. Other smart options include a break room, back-office workroom or additional storage space, or you might consider converting it to an in-office pharmacy, lab or drug-study room.
Decide which ancillary services would make the most sense for your practice: vision and hearing testing, a blood-pressure clinic, or even services you can “rent” for a set day each week such as mobile nuclear imaging. One of ChartCapture’s clients, a cardiologist in South Beach, Fla., sells his patients flash drives containing their medical records, which they can then bring with them on appointments with other physicians.
It doesn't happen overnight
While EMR is a smart step toward the future of medical-office management and practicing medicine, one thing is clear: the transition from paper files to EMR is neither quick, nor seamless. Depending on how long your practice has been around, the process can take from months to years to complete and may be done in several phases.
Usually, medical practices turn a subset of their paper records into EMR, which means a sizable amount of paper is still taking up space, according to Erica Drazen, managing partner of the emerging practices group within Computer Sciences Corp.’s healthcare sector in Waltham, Mass. “It’s very unlikely that [practices] will scan all the paper into EMR,” she says. “That’s a massive amount of information.”
Cohen agrees: “It does take them awhile once they transition to get rid of all that paper. They will often begin the process with all of their new patients that come in, while at the same time inputting information from their old files. If they have a substantial-sized file room, it can take them a long time to get rid of that paper.”
Ferguson asserts that saving money on office space or using the space more effectively is a side benefit of EMR systems, which are said to help practices operate more efficiently and effectively.
Space gain may be a wash
Keep in mind that at least some of the space you gain from purging paper files may be taken up with on-site EMR scanning equipment or the materials physicians need in order to use EMR and interact with patients.
“Some chart rooms are being converted over to computer use and being used as a mainframe storage area,” says Bruce Tyler, architect and principal for the healthcare division of architecture and design firm Baskervill in Richmond, Va. “In that case, you have to be very careful because electronic equipment creates a lot of heat, and it has to be properly ventilated.”
Also, once you convert to EMR, you may need to add more space-eating electronic systems in order to compensate for the lack of a physical chart. For instance, if you’re used to placing charts in door-mounted holders to signify to your nurses that they may bring in the next patient, you’ll need a new system once you’re no longer using paper charts.
For example, some practices have installed a light system to indicate when the physicians are ready for the next patient, Cohen says. These practices require a high-tech closet to house the “brains” for the new system, as well as a 24/7 cooling system.
However, most practices converting to EMR are choosing systems that are remotely located, alleviating concerns about space as well as patient confidentiality and privacy, which could be compromised if an on-site system doesn’t have the appropriate security in place, says Drazen.
Design change is imminent