Converting from paper charts
The transition can be handled with three distinct patterns.
The first is considered a rolling start. The rolling start involves the clinic starting their support staff on the new software with all new patients. Clinicians then work with the new system for new patients and the old charting system for existing patients. This is generally selected in clinics where their patient encounters are brief and patient loads turn over quickly. On this plan there are two systems that work in parallel to document patient data until the patient load has transitioned to the new electronic system and no paper charts are still in circulation. If patients return to therapy their data (treatment plans, psychosocial evaluations) may be uploaded into the new system from their historic charts to allow for continuity of care. This has the least labor diverted to clinicians and support staff, but can introduce confusion as there are two systems in play until the new system has replaced the old as patients are converted.
The second is a modified rolling start. In addition to the process described above, to facilitate patients being entered into the electronic charting system more quickly as they come due for either reviews or treatment plan updates clinicians enter them into the system. On this plan old information (intake forms, and last session note) may be uploaded into the system as clinicians who are working with existing clients upload their information to the new system. This is most commonly used where the patient base is largely stable and engaged in long term therapy. This process is typically selected by most single users as it quickly converts patients to one system, without being overwhelmed with entering all patients as described below or the need to maintain two systems as described above.
The last approach is a hard start. This is usually used when clinicians have large caseloads that are either already associated with an electronic charting system and they are migrating data or are part of collaborative care where there may be more than one staff responsible for patient charting. Here, if the staff have a pre-existing electronic record database the clinic will pick a date (usually a Friday) and have the upload started in a scheduled date when there is limited clinical activity. Our staff process the electronic data and have the imported material available for the clinicians the following Monday. When there is no existing electronic database this process requires clinicians or support staff to either upload forms from the old system or input data by hand for each patient at their first appointment after the deadline. This is the most labor intensive option for clinicians and is generally used when there is a dedicated medical records staff or support staff who can lead uploading forms or a relatively small patient caseload.
