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.
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:
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:
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.
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.
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