The Role of Shadow Charting in Healthcare: Ensuring Data Security

Healthcare's Digital Transformation

The adoption of Electronic Medical Records (EMR/EHR) is widespread in healthcare today. According to the CDC, nearly 86% of office-based physicians and 96% of non-federal acute care hospitals have implemented certified electronic record systems. This shift towards digital records enhances the tracking of patient health information, including medical history, test results, prescriptions, and interactions with medical providers. Even small, rural hospitals have embraced this change, with eight out of ten having adopted basic EMR systems.

The Continuing Importance of Shadow Charts

Despite the widespread use of EMR systems, many healthcare organizations still rely on shadow charts. These paper records, also known as "orphan" or "ghost" systems, contain crucial patient information and are often used in specific areas within an organization. Shadow charts might include components such as current complaints or test results. Providers may create a shadow chart from the complete medical record to take along for patient appointments or visits.

Reasons for Maintaining Shadow Charts

Several factors contribute to the continued use of shadow charts in healthcare:

1. Lack of Access to EMR: Some providers cannot access EMR due to interoperability issues or the absence of necessary computer equipment.
2. Implementation Phases: Organizations still transitioning to full EMR implementation may rely on shadow charts.
3. Satellite Offices: Remote patient exam areas use shadow charts to gather information, which is later entered into the EMR.
4. Cost-Effectiveness: Shadow charts can be a more affordable solution compared to establishing secure EMR links or placing computer equipment in unsecured locations.

Ensuring Patient Information Security

Regardless of whether patient information is stored electronically or on paper, HIPAA and other privacy and security regulations must be strictly adhered to. This includes ensuring that only authorized staff can access a patient's protected health information (PHI). PHI must be kept in locked file cabinets or password-protected computer databases to comply with these regulations.

As healthcare organizations move towards comprehensive electronic health records, shadow charts will still play a vital role. Here are some strategies to ensure the security and effectiveness of shadow charts:

1. Secure Binders: Use binders to hold individual patient information securely, providing privacy protection and easy identification for medical professionals.
2. Centralized Storage Units: Implement lockable storage units for binders to comply with regulatory requirements and ensure rapid access.
3. Mobile Chart Carts: For situations requiring mobility, use portable, lockable chart carts that can provide workspaces and ensure compliance with privacy protections.

EFFECTIVE STRATEGIES TO PROTECT PATIENT DATA

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.

To 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.

CONCLUSION

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.

REFERENCES

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 https://www.cdc.gov/nchs/data/nehrs/2017_NEHRS_Web_Table_EHR_State.pdf
2) Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008- 2015 https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehradoption-
2008-2015.php
3) Ghost charts and shadow records: implication for system design.
https://www.ncbi.nlm.nih.gov/pubmed/20841774