Practices that have not yet gone digital with their health records and Electronic Medical Records (EMRs) will need, sooner rather than later, to begin considering how they want to go about storing records -- both those that are already filed and those that are being created daily. Fortunately, the scanner, the central hardware in the analog-to-digital conversion process, is a mature technology, which makes choosing one relatively simple. But only after other decisions have been made.

"The subject of scanners comes up regularly," says Chapel Hill, NC physician David C. Kibbe , Senior Advisor for the American Academy of Family Physicians. "Last week on the AAFP Listserv there was a thread on scanning and there were probably 50 emails people talking about different scanners."

There are two primary reasons that practices purchase scanners, says Kibbe. One is to digitize paper records coming in from the outside so that they can be attached to a patients' EMR. The second is to archive old paper records on disk -- either for simple reference, or for legal reasons.

Peter Waegemann, the CEO of the Boston-based Medical Records Institute , which promotes information technology in health care, cautions against an easy prescription for selecting a document management system. "There's not any one path to take," he says. "There are different benefits for each physician and practice." To illustrate this, he points out that a "pretty good system" can cost as little as $1,000, but that the prices range up to $75,000, depending on the volume of documents a practice processes and, of course, its budget limitations.

Among the other considerations for selecting document management software, says Waegemann, are what particular functions physicians want, ease of use, and how you plan to go about archiving old records. Document management systems can be simple, with documents scanned as images and tagged with thepatient's name and a few other vital pieces of information. They can also be hardware intensive and require complex software that involves the use of Optical Character Recognition (OCR) to extract vital information and put it into a standard format, such as Continuity of Care Records (CCR).

If you boil the topic down to, as Whitehall, Pa.-based physician Lou Spikol, the senior health care information technology consultant for the AAFP puts it, "getting rid of the paper," there are only two main strategies to consider. The first is to scan in every single chart and record (which he doesn't recommend). The second is to scan only the historical records that are necessary while storing the rest off site. Then, when new paper charts come in, you enter critical information from those manually into your database, scan some of the more relevant, recent records, such as apatient's last EKG or mammogram, and finally putting those paper records into storage, as well.

In the end, choosing a scanner should be fairly simple, Spikol says. If your practice is going to be scanning in most, if not all existing paper records, you should buy a scanner that's fast, with the ability to scan about 40 pages per minute. A scanner that fast will have an automatic document feeder (ADF), meaning that you don't have feed one sheet at a time. And you should also examine the scanner's duty cycle rating, which is a published specification about how many pages a scanner can handle in one day and also over the normal lifetime of the device. If your scanning needs are lighter-duty, 25 pages per minute should be satisfactory.

The slower, lighter-duty scanners cost about $300, while the heavier-duty, faster scanners range up to $700 or so. All scanners in this price range produce high resolution images (150-600 dpi). Wireless connectivity shouldn't be a major issue, says Spikol, as standard USB connections are satisfactory for just about any office setup.

The bottom line
Scanners are a relatively mature office product, and models in the $300-$700 range should be powerful enough for the archiving and document management uses for most small-to-medium size practices. Among the standard features that you can expect in this price range are a 50 page ADF, duplex (double-sided) printing on the high end, and the ability to scan documents as readable and searchable Adobe Acrobat documents. Many come with both proprietary document management software as well as Acrobat and, often, Nuance's Paperport document organizing software. Most large business hardware companies, such as Xerox, Canon, Kodak, and Fujitsu, to name just a few, produce scanners in this price range