It seems whenever I ask long term and post-acute care providers whether they use paper forms, they respond apologetically: “Yes we use forms, but we know we shouldn’t.” Most providers think that there’s something inherently wrong with collecting information on paper. There isn’t. Paper is data, too.
Paper is used throughout the healthcare continuum, and used widely in long term care. It’s used to capture and store information in skilled nursing, assisted living, and CCRCs. Many QA Reader users rely on paper incident report forms to capture resident incidents, accidents, and near-miss information.
Pros and Cons of Capturing Data on Paper
Paper is an easy, user-friendly way to record patient information. You don’t need to train people to use a pen. Paper’s beautiful simplicity is the principal reason the medium has stuck around so long. You can take it with you wherever you go in the building. You can sit bedside and ask questions, and fill out a form. Taking a pen to paper is a very non-threatening, human activity. iPads aren't friendly.
Paper is good for collecting information, but it’s not great for storing it. In order to maximize the value of your paper process, you have to extract the information from paper and transfer it to some sort of digital media. Only when the data is in a digital format can you effectively analyze it and archive it.
Converting Paper Files to Digital
The question then becomes, What is the best method for converting paper records to digital? Here are three methods to convert the information on paper to a digital format.
Manually Enter the Data
The most popular (and costly) method for transferring data from paper to digital format is by typing it into a spreadsheet or database. In our experience, skilled nursing and assisted living communities rely on their most qualified staff members (DONs, ADONs, RNs, EDs, etc.) to transfer the data from incident reports, wound logs, and other forms into a spreadsheet.
Outsource Data Entry
Many industries, including healthcare, use offshore data processing centers to transfer information from scanned documents to spreadsheets. This is a pretty good option, if you can get past the security risks in transmitting personal health information (PHI) overseas. You can get a full time equivalent (FTE) data entry clerk for about $1,000 per month. That’s roughly six bucks an hour.
Use Technology to Convert the Data
This is my favorite method. If you create your forms correctly, you can use optical mark recognition (OMR) and optical character recognition (OCR) technology to facilitate the data transfer from your paper form to digital format. QA Reader uses a combination of OMR, OCR, and domestic quality assurance teams to transfer data from faxed paper incident report forms to a HIPAA-compliant encrypted data store. You can digitize the incident and accident reports of an entire skilled nursing facility and get a comprehensive risk management dashboard for about 20% the cost of an offshore FTE. Alternatively, you can purchase OCR/OMR software from ABBYY that will read your PDFs into a CSV file for about $15,000 and $2,500 per year.
There are tradeoffs to each of these methods. When a highly skilled caregiver types in the information from the form, he or she reads the form and internalizes its implications. This can be a good thing. If you offshore the data entry, you save money but you create management work for someone in your organization. Someone has to manage the foreign firm and the HIPAA risk. Finally, if you use technology to do the work for you, someone has to vet the software and the vendor, and incorporate the technology into your existing process.
There’s also a higher level tradeoff that should be reviewed: is your paper process maintaining or improving quality of care? Collecting data on paper forms isn't antithetical to QAPI or process improvement, generally. You just have to get the information off the paper as soon as possible.
So, don’t hang your head when someone asks you if you use paper documentation at your skilled nursing facility (SNF), assisted living facility (ALF), or continuing care retirement community (CCRC). Paper is data, too.
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