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walkitoutThis is only very peripherally about genealogy, so I am not tagging it genealogy.
Regular readers know that I am fascinated by format transitions. Disruptive innovation is great in general (well, not for the disruptee, obvs), but I really love format changes, because they are so ... sneaky.
Speaking of long ago, I used to do clerical temp work, before I got my degree and got Real Jobs. I type fast and mostly accurately (more accurately if I'm poor and people are paying me, hence all the errors these days) and once upon a time I was wicked quick at 10 key. There was one job in particular that stuck out in my memory, because it had a whole set of stories associated with it. I pulled records involving a man who actually had the name Sherlock Holmes. I ran across medical records involving various people I knew, including a high school classmate who accessed reproductive services while we were both in high school. This was all pre-HIPAA, and while there was a decent informal culture of Don't Talk About What You See Even If It Is A Juicy Story and You Know the Person, I was basically happy to start having to sign a bunch of forms post-HIPAA, because I also knew what happened when we were on break. "Hey, guess what I saw today!"
So, why did I see so much? Because I was printing records from microfilm storage so that claims adjusters could adjust claims. (I've never been a claims adjuster so I am a little hazy on those details.) If you haven't had the pleasure of using a microfilm system, it's a spool of film that goes into a machine. There is a label on the spool (you sure hope, anyway) indicating the range of records stored on it (by date, serial number, last name, wtf), and you basically hit go forward or go back, stop, take a look at where you are, lather rinse repeat. I read very quickly with good comprehension and can skim at an unholy rate, so I was a walking privacy violation for anyone who had a record stored anywhere in that system.
It is easy, when thinking of office automation in terms of computers, to forget how pervasive microfilm once was (here in the United States. Because of certain aspects of the technology, such as storage requirements, and because of the comparative expense of the machines, it was not as widely adopted in most of the world), and how persistent it still is. I do genealogy almost exclusively online, but when I break down and send away for court records, I get paper print outs from the court's microfilm system. There are tons of records that I'm not accessing until they get scanned from microfilm and put up on ancestry.com or elsewhere; I'm not in that much of a hurry. (Well, okay, I suppose if the kids grow up and find other things to do with themselves, I probably _will_ go digging around in those records. But that's still a ways off.) It is easy for me to believe that there are still offices out there that are running off of microfilm, and I keep waiting to see when that turnover is finally going to happen.
I think it is. Here's my evidence: I have a friend who is temping in Seattle using claims adjustment workflow software that handles nearly any kind of input, but can be end-to-end EHR. It's new -- so new that the training is out of step with the software because they are getting frequent updates. The rest of my evidence is a sense that enough health care providers have finally scanned the contents of their file room(s) (receiving in exchange additional exam room(s) or office space) in order to move to EHR. The entire rationale for microfilm is to make paper storage smaller. As paper inputs wane, the last reason for retaining a paper-centric workflow dissipates. With computer storage as cheap as it is now, it's really just a matter of the labor involved in scanning historic records.
Here's a 2008 article about how to handle older records when transitioning medical records to EHR. Microfilm and microfilm are listed as a viable option, altho not a preferred one.
http://www.fortherecordmag.com/archives/ftr_01212008p10.shtml
The article also discusses whether or not to keep paper originals.
Here's someone contemplating a big conversion project, and answers from 2011:
http://ask.metafilter.com/197920/Microfilm-Digitization-Whats-the-Better-Machine
Notice that at this point, the machines that center, and do a really go job of auto-focus and so forth to deal with lower quality (not straight up and down, for example) images are expensive, and it is horribly labor intensive to do it manually, but people were hiring temps to just do the project. And you don't get structured data out of this -- just images on a computer, instead of images on film.
Hey, a blast from the past in this title from the early 1980s:
http://www.ncbi.nlm.nih.gov/pubmed/10295218
"Small office microfilm cures medical insurance paperwork problems."
And you wonder why people were so reluctant to computerize their paper charts and health records.
If you go to monster.com and search on keyword "microfilm" or similar, it does not take any real effort to find current postings that ask for some amount of proficiency using microfilm. Ancestry.com might hire you for around $10 to work on digitizing microfilm. But most of the rest of the postings are clerical positions that will straightforwardly access records stored on microfilm. While there are many, many, many businesses around to help convert your microfilm to records, with some degree of automation bringing the price down, they are still focused pretty intently on libraries and also on newspapers which are trying to monetize their morgues. There isn't as much focus on moving the health care industry off of microfilm and onto digital storage.
Here's a jumpstation provided by the New York State archives:
http://www.archives.nysed.gov/a/records/mr_cons_conversion.shtml
My husband thinks that there's a lot less usage of microfilm in healthcare than I think there is. But he has also observed that the transition from microrecords to digital storage, when he has encountered it, tends to not be discussed. Like at all. So where I would usually conclude by saying, I guess we'll have to see what happens, this particular transition might be largely invisible.
Regular readers know that I am fascinated by format transitions. Disruptive innovation is great in general (well, not for the disruptee, obvs), but I really love format changes, because they are so ... sneaky.
Speaking of long ago, I used to do clerical temp work, before I got my degree and got Real Jobs. I type fast and mostly accurately (more accurately if I'm poor and people are paying me, hence all the errors these days) and once upon a time I was wicked quick at 10 key. There was one job in particular that stuck out in my memory, because it had a whole set of stories associated with it. I pulled records involving a man who actually had the name Sherlock Holmes. I ran across medical records involving various people I knew, including a high school classmate who accessed reproductive services while we were both in high school. This was all pre-HIPAA, and while there was a decent informal culture of Don't Talk About What You See Even If It Is A Juicy Story and You Know the Person, I was basically happy to start having to sign a bunch of forms post-HIPAA, because I also knew what happened when we were on break. "Hey, guess what I saw today!"
So, why did I see so much? Because I was printing records from microfilm storage so that claims adjusters could adjust claims. (I've never been a claims adjuster so I am a little hazy on those details.) If you haven't had the pleasure of using a microfilm system, it's a spool of film that goes into a machine. There is a label on the spool (you sure hope, anyway) indicating the range of records stored on it (by date, serial number, last name, wtf), and you basically hit go forward or go back, stop, take a look at where you are, lather rinse repeat. I read very quickly with good comprehension and can skim at an unholy rate, so I was a walking privacy violation for anyone who had a record stored anywhere in that system.
It is easy, when thinking of office automation in terms of computers, to forget how pervasive microfilm once was (here in the United States. Because of certain aspects of the technology, such as storage requirements, and because of the comparative expense of the machines, it was not as widely adopted in most of the world), and how persistent it still is. I do genealogy almost exclusively online, but when I break down and send away for court records, I get paper print outs from the court's microfilm system. There are tons of records that I'm not accessing until they get scanned from microfilm and put up on ancestry.com or elsewhere; I'm not in that much of a hurry. (Well, okay, I suppose if the kids grow up and find other things to do with themselves, I probably _will_ go digging around in those records. But that's still a ways off.) It is easy for me to believe that there are still offices out there that are running off of microfilm, and I keep waiting to see when that turnover is finally going to happen.
I think it is. Here's my evidence: I have a friend who is temping in Seattle using claims adjustment workflow software that handles nearly any kind of input, but can be end-to-end EHR. It's new -- so new that the training is out of step with the software because they are getting frequent updates. The rest of my evidence is a sense that enough health care providers have finally scanned the contents of their file room(s) (receiving in exchange additional exam room(s) or office space) in order to move to EHR. The entire rationale for microfilm is to make paper storage smaller. As paper inputs wane, the last reason for retaining a paper-centric workflow dissipates. With computer storage as cheap as it is now, it's really just a matter of the labor involved in scanning historic records.
Here's a 2008 article about how to handle older records when transitioning medical records to EHR. Microfilm and microfilm are listed as a viable option, altho not a preferred one.
http://www.fortherecordmag.com/archives/ftr_01212008p10.shtml
The article also discusses whether or not to keep paper originals.
Here's someone contemplating a big conversion project, and answers from 2011:
http://ask.metafilter.com/197920/Microfilm-Digitization-Whats-the-Better-Machine
Notice that at this point, the machines that center, and do a really go job of auto-focus and so forth to deal with lower quality (not straight up and down, for example) images are expensive, and it is horribly labor intensive to do it manually, but people were hiring temps to just do the project. And you don't get structured data out of this -- just images on a computer, instead of images on film.
Hey, a blast from the past in this title from the early 1980s:
http://www.ncbi.nlm.nih.gov/pubmed/10295218
"Small office microfilm cures medical insurance paperwork problems."
And you wonder why people were so reluctant to computerize their paper charts and health records.
If you go to monster.com and search on keyword "microfilm" or similar, it does not take any real effort to find current postings that ask for some amount of proficiency using microfilm. Ancestry.com might hire you for around $10 to work on digitizing microfilm. But most of the rest of the postings are clerical positions that will straightforwardly access records stored on microfilm. While there are many, many, many businesses around to help convert your microfilm to records, with some degree of automation bringing the price down, they are still focused pretty intently on libraries and also on newspapers which are trying to monetize their morgues. There isn't as much focus on moving the health care industry off of microfilm and onto digital storage.
Here's a jumpstation provided by the New York State archives:
http://www.archives.nysed.gov/a/records/mr_cons_conversion.shtml
My husband thinks that there's a lot less usage of microfilm in healthcare than I think there is. But he has also observed that the transition from microrecords to digital storage, when he has encountered it, tends to not be discussed. Like at all. So where I would usually conclude by saying, I guess we'll have to see what happens, this particular transition might be largely invisible.