Downtime, Paper Charting

TITLE
Paper Charting System for System Downtime/Power

Outages
ORGANIZATION LEVEL CATEGORY

Michigan Health Clinics Organization Clinical
POLICY STATEMENT
The Company will have an established process for paper charting which will be used only in
the event of utility disruption or Electronic Medical Record (EMR) system downtime.
PURPOSE
The purpose of this policy is to establish procedure for paper charting guidelines in the
event of utility disruption or EMR system downtime and to ensure that the most current
information is available to all staff members/facilities.
RESPONSIBILITIES
All workforce within Michigan Health Clinics that utilize the clinical EMR system for patient
charting.
PROCEDURES
Paper charts should not be used at any time that the current EMR system is available for
use.
Staff will frequently monitor the systems for connectivity and function and begin using the
EMR immediately as it becomes available.
Paper charts will be scanned into the EMR system as a permanent record and for electronic
claims billing.
Paper charts will be securely destroyed and disposed of after scanning and once the facility
receives confirmation of completion from billing.
All entries into the medical record whether electronic or on paper will be legible, complete,
dated, timed and signed with appropriate credentials. Documentation will be completed
prior to discharge from the facility when possible but no later than 48 hours after discharge
from the facticity.
Documentation Requirements:
1. Black ink will be used for all legal medical record documentation.
2. Each page of the chart should include the patient’s name, date of service, and unique
patient identifier.
3. The provider will indicate written orders, test results, and plan of treatment on the
Medical Progress Note.
4. All treatments, medications, and patient responses must be documented on the
Nursing Notes.
Page 1 of 4
5. If an error in documentation occurs, no erasers or white out eradicators are allowed.
Corrections will be made by drawing one line through the error with black ink, write
“void” above the error, and initial.
MHC staff and providers will follow the procedure set forth below.
1. A checklist may be utilized to track and confirm initial completion of established

processes for Paper Charting for System Downtime
2. Approximately 30 paper charts are preprinted and easily accessible at any given
time.
3. Templates for additional printing can be access from the clinic drive folder.
4. For instances of clinic drive network disruption, templates of all forms are kept in a
Master forms binder.
5. For instances of prolonged system outage or paper supply disruption or utility
outage, facility closure with public notification would be warranted.
6. The Patient Registration Log will be utilized as a manual paper schedule during
system outages. Clinical and clerical staff are to use this as a reference to keep
patients in order.
Customer Service Representative (Receptionist)

1. Once systems are down the CSR is to retrieve copies of paper charts kept in a folder
at the front desk.
2. Provide each patient with the Consent and Chief Complaint form and Registration
form. Include the separate Medicaid consent if necessary.
3. Obtain patient’s picture ID and insurance card. Make a photocopy of the front and
back of both cards if utility functions are functional.
4. If the internet is not available CSR will inspect patient’s insurance card for a listed
copay or deductible amount. If the card does not list a copay or deductible amount
the CSR is to ask the patient if they know their urgent care coverage. If they do not
know, the CSR will tell the patient, “We will submit today’s visit to your insurance and
you may receive a bill for services not covered.”
5. Upon completion of paperwork, the patient will bring completed forms back to the
clerk at the desk. Visually inspect the paperwork to make sure all forms are
completed and signed.
6. Collect copay amount if applicable. If a patient has a deductible plan, collect at check
out.
7. If the credit card machine is not working the CSR will attempt to collect payment by
requesting cash or check. If a patient does not have either method of payment we
will bill the patient.
8. The CSR is responsible to fill out each page of the paper chart with the patient
information: Patient’s name, Date of Birth, Date of Service
a. Nursing notes
b. Doctor’s notes
c. Paper Chart Template
d. Discharge instructions
e. Superbill/Diagnosis Code: Patient’s Name, Date of Service, Date of Birth,
Treating Physician, Patient’s address, Insurance Information, Copay amount,
and Payment received.
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9. Once all paperwork is complete, the CSR will visually inspect all forms front and back
to confirm completion; This packet should include the following:
a. Copy of patient’s ID and insurance cards.
b. Registration Form
c. Consent and Chief Complaint Form
d. Paper chart Packet (5 Forms)
10. CSR is to write patient information onto the patient registration log.
a. Patient Name
b. Time of arrival
c. Insurance Type
d. Amount patient paid and payment type
11. In the notes section put, “paper charts” if the system is down to help you track the
patients.
12. The CSR is to walk the completed patient packet to the clinical staff. Preferably
given to the nurse.
13. Once the patient is seen and the provider and clinical staff complete their portion,
Paper Charts will be brought back to the front desk.
14. CSR will check Superbill for visit charges. CSR is to use their clinic fee sheet to total
visit charges.
15. Collect payment from patients. If the credit card machine is down, request cash or
check for the patient's payment method as discussed with the patient at check-in.
16. CSR is to notify the Director of the billing department and the Director of Operations
If there have been paper charts generated.
17. CSR is to keep all paper charts together and organized at the desk to be prepared for
next steps.
If the system becomes accessible prior to the end of the shift:

1. Designated scanner will take completed paper chart packets and begin putting the
patients into EMR
2. Search for patient in the EMR
3. If patient is new, create the patient a chart by filling in all patient demographics from
registration and consent form into the demographic screen.
4. Place the patient on the clinic schedule
5. Scan the entire paper chart packet into the EMR. Do not destroy charts at that time.
6. Enter patient payment on payment screen
7. Once the charts are scanned, give charts to the provider to review.
8. Once the provider has completed all charts, forward charts to the facility manager to
review.
9. Once billing has verified that charges have been dropped, charts may be securely
destroyed and disposed of in a shred bin.
If the system remains inaccessible for the remainder of the shift or prolonged time frame:
1. Please notify the Director of Billing the Director of Operations if there have been paper
charts generated.
2. Place charts in envelopes and give them to the Center Manager if systems have not
come back up prior to the end of business day.
3. Once the system is back up the Center Manager will give the charts to the CSR.
Page 3 of 4
4. CSR will take completed paper chart packets and begin putting the patients into the
EMR.
5. If the patient is new, create the patient a chart by filling in all patient demographics from
registration and consent form into the demographic screen.
6. CSR will place patients on the actual visit date schedule. You will select the correct visit
date on the schedule screen in the calendar box.
7. Scan the entire paper chart packet into the EMR. Do not destroy charts at that time.
8. Once billing has verified that charges have been dropped., charts may be securely
destroyed and disposed of in a shred bin.
ATTACHMENTS
EMR Downtime Patient Chart Documentation Form
EMR Downtime Discharge Instructions Form
Page 4 of 4

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TITLE

Paper Charting System for System Downtime/Power

ORGANIZATION LEVEL CATEGORY

1. A checklist may be utilized to track and confirm initial completion of established

Customer Service Representative (Receptionist)

If the system becomes accessible prior to the end of the shift:

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