SAN DIEGO – For those healthcare institutions unwilling or unprepared to make a complete transition to electronic medical records, a “hybrid” record – which includes both paper and digital files – may be an attractive alternative.

A hybrid medical record appeals to some hospitals because of an institution’s paper legacy, said Raymond Gensinger, Jr., MD, at the HIMSS Summit 2007 conference earlier this week.

Gensinger, currently Deputy Medical Director at Hennepin County Medical Center in Minneapolis, noted that most institutions have extremely large volumes of paper data and a precipitous change to digital records could prove overwhelming.

“A hybrid record is a kind of risk mitigation strategy,” Gensinger said. “And truthfully, no system is completely paperless. There will always be some forms of paper even in the most electronic hospital.”

This unavoidable paper – such as outside correspondence, consent forms, and immunization records – along with the unplanned downtimes that can hit any digital system, make a hybrid record appealing, Gensinger told healthcare CIOs at the annual HIMSS leadership event.

He said that there are two types of hybrid record: a combination EHR and paper chart, and an EHR with document imaging. The latter option may be the best if an institution hopes to become completely electronic sooner rather than later.

“The hybrid record with document imaging eliminates the need for maintaining a paper chart and the storage space and cost issues that go along with it,” Gensinger said. He acknowledged that there were challenges associated with the document imaging hybrid model, and made a few important recommendations to those institutions considering it.

Those recommendations include: scan or abstract key historical information; have a detailed indexing strategy; track documents by encounter date; bundle document types together (e.g., progress notes and ambulatory visits); call out documents of significance (e.g., anesthesia records).

Ultimately, the major drawback to a hybrid record is that it “postpones the inevitable,” according to Gensinger. For this reason, hospitals moving to digital records may want to transition quickly, via the “big bang” method.

Andrew Mellin, MD, vice president of advanced clinical technology at San Francisco-based McKesson Healthcare, spoke at the HIMSS Summit with Gensinger and claimed that the “big bang” approach would mean a much faster return to productivity in the hospital.

“You have to be able to drop other priorities to focus on a big bang transition,” Mellin said. “But the users are much happier after the fact than if you go gradually.”

He offered as an example the experience of United Hospital in St. Paul, Minn. Part of the Allina Hospitals & Clinics system, United was able to go paperless in four weeks with little disruption to workflow.

“You must have strong leadership for the big bang transition to work,” Mellin concluded. “It has to be a priority from the very top.”