Howard McCollister cut
A strategy I suggested was to include a field indicating legacy records existed for each patient put all *new* records on the computer system. Work practices would be to check the computer and then, if legacy records existed, pull the paper file. Practically no conversion costs and the system would evolve toward maximum efficiency at a natural pace.
Only if you want everything done at once. This is the same for every project. You could have a house built in a couple of days for a $million, or you could have it built over a month for a hundred thousand. People tend not to think about computer projects the same way they do physical projects.
A patient management system for a small practice can be done in MS Access in a day. From scratch. Prebuilt systems can be installed in an hour. Populating the system with legacy data may take weeks, up to a month or so, using clerical level data entry personell. An alternative is to process each paper record as it is used, then archive it instead of returning it to the paper filesystem. This would ensure current files and high usage information were on the system ASAP at very little cost.
Considering the time people spend in waiting rooms it may even be possible to do this in real time and have the information on the doctor's screen by the time the patient enters his office.
Middleware is your friend here. It is possible to write intranet based middleware that can that extracts data from a variety of sources and compile reports as necessary. If the information is stored electronically it is a fairly simple matter to pull it in and reformat it as needed. A data cube of such information, computed overnight, would allow easy access without impinging on business hours transactions.
The issue is one of systems analysis. You do not need a mbuttive Oracle or SQL Server based system, capable of real time processing for a hundred thousand simultaneous users, just to support two doctors and a nurse.
A few years back I ran an electoral management system for 80,000 consbreastuents on a 486 based microcomputer with a 500Mb hard drive and 128k of memory. It worked as required.
Today I write this on a P4 2GHz laptop with 2Gb memory and 80Gb of disk space. The article comes to you initially over a 56Mb-s WPA encrypted wireless link. This system could run a small hospital and would be overkill for a normal medical practice. Yet it is a standard high end laptop today.
Computerisation of medical records really is fun, I just wish more people would join in.
DM personal opinion only