EMR Data Archiving – The Problem with PDFs of Patient Records

Another very popular strategy many physicians use to archive records is to export them to series of PDFs.  However, it has many issues of its own.

The first issue is that of whether attachments, or scanned documents, are included in the actual PDF itself.  If they are then there are concerns as to whether or not the PDFs actually meet the Colleges/CMPA requirements of ‘Legibility’ for all records in a doctor’s care.  The problem here is that most scanned documents are scanned in from pieces of paper in a doctor’s office – which would mean 8.5×11 inch sheets of paper.  As most vendors use standard reports to export the patient information out to a PDF file this means that you are then trying to print a 8.5×11 document on a 8.5×11 document – which cannot be done without scaling.  It is the scaling that causes the problem.  As most export functions use a standard report to do this – and they print typically to a laser printer – the resulting PDF has the same characteristics.  These characteristics including having a standard ¼ to ½ inch border around each side of the document – which means that you are no longer able to print an 8.5×11 on an 8.5×11 area – but rather at best an 8×10.5 area.   As well – on that page you probably would want some Meta data – such as doctor name, date of the document and possibly some notes.  This means your printable area is now more likely at best 8×9 inches.  So – you have two choices at this point.  You can either print proportionally or stretch to fit the area.   Either are compressing the image to fit – and possibly distorting it.  Because computers scale down images often during document handling, the worry is information could be lost in that scaling – either through distortion, or strict data loss.  Will commas read as periods alter the meaning of the document?  Will the height to width ratio of a black spot on a tumor change the diagnosis?  We cannot tell with certainty – certainly not to the level required by college retention requirements.

The second issue is that of purging.  The doctor needs to purge each medical record as it reaches the end of its retention period.  Considering that a typical doctor will have at least 6,000 patients in his/her EMR when they retire (with only about 2,000 being active patients) – the doctor will have to search through each PDF every 3 to 6 months (to show due care) and find that last time they touched that medical record.  That would probably have to be the last chart entry – and not appointment – as patients will just not show up at times.  How many doctors (especially those who are retired) do you think will take the time, or even remember to do this?  This means that they are exposing themselves to added liability by not properly destroying the records when they are required to do so.

The doctor cannot simply delete the file (from Windows, Apple or Linux computers)  – but must use a tool like Eraser – which securely deletes a file from disk.  Add to that the requirement to delete all external attachments if the PDF was created properly with the scanned documents being stored externally to the PDF.  As some patients can have 100+ attachments – this can become a rather long, cumbersome and error prone task.

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