Shadow Charts In Healthcare


In 2017, the Centers for Disease Control (CDC) determined that nearly 86% of office-based physicians are using an Electronic Medical Record (EMR/EHR). 1 Ninety-six percent (96%) of non-federal acute care hospitals had implemented a certified electronic record system to track patient health information including medical history, test results, prescriptions and interactions with medical providers. 2 At least eight out of ten small, rural hospitals have also adopted a basic EMR. Healthcare is computerizing electronic medical records.


Even though doctor offices, clinics and hospitals have implemented an electronic medical record system, many are still utilizing “shadow” charts, a paper record of patient information in one or more areas within their organization. Shadow charts are also known as “orphan” or “ghost” systems and often only include one component of a full patient medical record such as current complaint or test results. In some cases, providers may create a shadow chart or sheet of pertinent information from the complete medical record to take with them for a patient appointment or visit.

shadowchartsThere are several reasons for an organization to create and maintain a shadow chart. In some environments healthcare providers cannot access the EMR, either due to a lack of interoperability or not having computer equipment available. In other cases, the organization may still be in the implementation phase of moving to an EMR and all patient care areas do not have access.

For organizations that have satellite offices or remote patient exam areas, shadow charts are employed to gather information that can then be manually entered into the EMR at a later date. As the direct costs of shadow charts are minimal, a shadow chart may be more cost-effective solution than establishing a secure link to the EMR or placing computer equipment in an unsecure location.



Regardless of how patient information is stored, electronically or on paper, or a combination of storage strategies, HIPAA and other privacy and security regulations must be fully met. These regulations require that shadow charts must fully meet the privacy and security requirements of federal and state
law. For compliance purposes only authorized staff can access to a patient’s protected health information (PHI). Either on a computer or in a paper file, PHI must be maintained in locked file cabinets or folders or password protected computer databases.

View Our HIPAA-Compliant Chart Cart


Even as healthcare organizations move to deploy an electronic health record to all patient areas, shadow charts will continue to be utilized. There are several strategies to support shadow chart operations while ensuring that patient data is fully protected.

Binders securely hold individual patient information and provide privacy protection as each binder can be identified and only accessed by the medical professional treating the patient. These cost-effective binders provide a durable and scratch resistant solution and some include an antimicrobial infection resistant covering when infection prevention is a priority.

Having a centralized and lockable storage unit to house the binders is essential in regulatory compliance and an industry best practice. A unit that can accommodate multiple binders maintains patient information security as well as rapid access when needed. The chart carts can be configured to be portable, so medical professionals can bring the shadow chart binders to various locations within an organization without needing to retrieve binders from a centralized location that may not be easily accessible.

eliteIIIemailTo select the optimum chart rack, an organization should determine the number of charts that need to be accessed. In the situations where the chart needs to be moved from location to location, or bed to bed, a mobile cart should be employed. If necessary carts can also provide counter height work spaces to complete the patient record. All chart rack carts should be fully lockable for HIPAA and other regulatory privacy protection.


Healthcare organizations and medical providers will continue to fully implement electronic medical records in the coming years. In the interim, cost-effective and secure systems to support shadow charts should be deployed to ensure streamlined access to patient information while complying with regulatory requirements.

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1) Percentage of office-based physicians using any electronic health record (EHR)/electronic medical record (EMR) system and physicians that have a certified EHR/EMR system, by U.S. state: National Electronic Health Records Survey 2017
2) Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008- 2015
3) Ghost charts and shadow records: implication for system design.