At long last, the practice was able to get rid of its final paper charts earlier this year. “They’re actually moving their physical therapy facility, which was in another building, into that space, which was doing nothing but storing charts. They are freeing up $100,000 in rent and moving their facility into where their chart storage used to be. It’s amazing,” says Bonini.

Check your state regulations for retaining medical records. Chances are good that your practice is going to have some kind of paper — even if it’s just in storage — for a few years after implementing an EMR. If your practice is small enough or new enough, you could consider scanning all of your patient charts, but don’t expect that to be a rapid process either. Springfield Cardiology spent nearly nine months scanning in only five years’ worth of charts for its three physicians.

Is paperless pointless?

Everyone pretty much says the same thing: Forget about paper, and think about being more efficient. To that end, you may find certain areas where paper just can’t be excised from your practice — and that may not be such a bad thing.

Many practices, for example, find it difficult to eliminate patient history summaries on paper. Physicians generally read a chart summary before entering the exam room so that they can familiarize themselves with the patient’s history. One practice Moore dealt with had dispensed with that paper summary altogether. “The physician opened the door and literally did not know who was in there,” she says. “Talk about a problem with patient service.”

How will your practice’s patients react to a physician who has to go directly to the exam room laptop before having a conversation?

To avoid problems like these, Springfield Cardiology still prints “doctor data sheets” for its physicians. “As long as it doesn’t slow down the efficiency of the organization, I don’t have a problem with a temporary piece of paper and shredding it afterward,” says Shaikh.

A number of practices also continue to print out the daily schedule. Even though work flow may be coordinated through the EMR, the staff is accustomed to working from a paper schedule. “If that helps you and helps your work flow, you shouldn’t feel like you can’t print out that schedule because you’re not allowed to have paper,” says Moore. “The main objective is work flow, not getting rid of paper.”

Certain specialties may find it particularly difficult to shed visit documentation. Nelson cites pediatric practices as one example: “Pediatricians have done a very good job of creating paper forms or templates, especially for well-child visits. They pull out the form based on what that patient’s visit is for, and they’ve got something that’s really easy for them to fill out by hand, check off the boxes, and do that quickly.”

Something like that could be incorporated into the EMR, but it doesn’t have to be. If checklists and forms like these work well for your practice, there’s no reason to discontinue them simply because they are paper-based. Just build a step into your practice’s work flow that allows those checklists and forms to be scanned into the patient file later. A temporary piece of paper like this one can help your practice work flow much more than it hurts.

If you want it badly enough

Maybe paper isn’t so bad after all, but your practice still wants to eliminate it completely. If you really want to make it happen, you can. Look at North Carolina Orthopaedic Clinic in Durham, N.C., where John Bonini has overseen another EMR conversion. It has no chart room and no space for filing paper of any kind.

“I can truly say that there is not a piece of paper that we haven’t gotten rid of,” says Bonini.

Not only did the practice scan all of its patient charts. It also dispensed with printed chart summaries and daily schedules. A terminal outside the nurses’ station allows physicians to review patient histories before entering the exam room.

It took a lot of homework for the practice to get to this point, Bonini says. Every step of the practice’s digital conversion — from scanning patient records to implementing work flow solutions — was planned in advance. Although many EMR companies provide a checklist for how to go paperless, Bonini knows those checklists don’t tell practices how to look at work flow, conduct internal meetings, and figure out what to do with paper charts. “EMR companies don’t manage medical practices,” says Bonini. “What do they know about that? They know how to make their software help you, but they don’t know how to tell you how to improve your office to accept this solution.”