The Administrator’s Desk: The Power of Paperless

March 1, 2009

Not ready for an EMR? No problem. Start with baby steps to reduce your paper.


It’s hard to talk shop these days without someone bringing up the word green, sustainable, or eco-friendly. Indeed, Americans - both corporate and consumer - are tackling the challenge of climate change with a renewed sense of purpose and taking aggressive new steps to preserve our environment for future generations. For businesses, one of the easiest ways to affect change is to join the paperless crusade. The benefits are clear. An automated office not only creates less waste (the Worldwatch Institute research group in Washington, D.C., estimates the average U.S. office worker uses 12,000 sheets of paper a year), but translates into bigger profits by increasing productivity.

For medical practices, the benefits of moving from a paper-based office to an electronic one are greater still. Electronic medical records all but eliminate the need for document storage, freeing up space in your practice for another exam room. It also reduces incidents of human error, speeds payment processing, and helps reduce paper clutter that drags on efficiency.

Despite the obvious upside, however, many practices have been slow to embrace the paperless trend, either from fear of having to invest in a pricey EMR or because of resistance from the staff.

“As soon as someone says ‘paperless,’ practices think they have to implement a full EMR, but if they take just one smaller step they’ll see so much improvement that they’ll be inspired to take the next step,” says Rosemarie Nelson, technology consultant for the MGMA Health Care Consulting Group.

Baby steps

Indeed, there’s a lot you can do as practice administrator to begin converting to a paperless office without breaking the bank. For starters, you can require employees to use both sides of the paper at the printer, and use all available white space on previously printed paper for taking notes. You should also post employee manuals online. And before you recycle all those unwanted catalogues and junk mail, be sure to call (or have someone on your staff call) the senders and request that your name be removed from their mailing list to reduce future waste.

A small investment in technology, of course, will yield the biggest bang for your buck. There are countless products available for purchase à la carte that perform some of the functions of an EMR, including automated billing, scheduling, and patient registration. For a few hundred dollars, for example, you can arm your physicians with personal digital assistants (PDAs), like the Blackberry or Pocket PC, that enable them to capture charges, update charts, and download data from any location - including the hospital. Before you buy, however, be sure to touch base with all your physicians’ hospitals to find out which electronic systems they can support, says Debra Wiggs, interim director of central billing for Foothill Cardiology in Pasadena, Calif., and a practice administrator for 25 years. “It can be a soft sell of a full blown EMR,” says Wiggs. “It gets your physicians in on the idea that they have to get comfortable using technology.”

Need another cost-effective way to reduce paper waste and improve efficiency? Use a digital fax server to eliminate the paper faxes you receive for incoming lab and imaging reports. “Usually with imaging report faxes, a hard copy comes in by mail in two or three days anyway,” says Nelson. “It’s easy to undo all the fax nonsense that goes on.”

E-prescribing

In the pursuit of the paperless practice, however, electronic prescribing is perhaps the most effective incremental step towards full EMR implementation. “Twenty five percent of the calls that come into a primary-care office are for prescription refills, which generates yet another piece of paper for a note,” says Nelson. “Then, the clerk has to pull a paper chart and create another note to have someone fax it to the pharmacy.” Using an e-prescribing system, the nurse could message the physician at the point of the phone call and send the prescription refill electronically to the pharmacy. “This is not a big expensive piece of equipment,” says Nelson, noting you’ll also eliminate countless call backs from the pharmacy because they couldn’t read the writing on the paper prescription.

It’s worked so far for Paul S. Cohen’s internal medicine practice in Syracuse, N.Y., which put plans on hold for a more expensive EMR earlier this year while they rolled out an e-prescribing system. “We’ve been in the process of looking at various EMRs, but we kept hitting a roadblock because of the cost and because there are so many products out there. We would get to the point where we didn’t even know what questions to ask,” says Anne Richards, laboratory and technical manager for the practice who is spearheading their paperless initiative. “We phased in our e-prescribing software one physician at a time and eventually got the whole staff up and running. It was a great stepping stone to going completely paperless.”

If your doctors need convincing, remind them that Medicare is offering practices that successfully utilize e-prescribing software an extra incentive of 2 percent of their allowable medical charges per visit. That incentive remains effective, but shrinks over the next few years; in 2011 and 2012 it decreases to 1 percent, and in 2013 it’s only 0.5 percent. Starting in 2012, practices that are not yet e-prescribing will start to lose 1 percent of those charges as a penalty.

Let the scanning begin

Lastly, you may also want to explore imaging technology, which allows your staff to scan in paper records and convert them to electronic files. Such software enables your practice to destroy old paper records, save them electronically in a secure hard drive and retrieve them in a matter of minutes. According to Wiggs, it often works best to instruct your staff to start scanning in all new paperwork to your system as it arrives, and later designate a member of your staff to start working backwards and scan in all your paper archives to the system.

For its part, DST Health Solutions offers the Automated Work Distributor (AWD) product that, in part, allows for document imaging. Depending on the product size and your practice’s needs, the AWD technology can cost as little as $10,000 to $15,000.

“A huge benefit of storing your records electronically is the ability to access those records from multiple locations simultaneously, which is particularly important if you have more than one location,” says Gray. “A lot of practices have doctors who divide their time between a clinic one or two days a week and their main office.”

Assess your needs

Before you purchase any technology to automate workflow, however, Wiggs suggests you should take the time to determine your needs. “The critical conversation that practice administrators need to have with their staff and their physicians is where are you now, where do you want to be, and when do you want to get there,” she says. “If you’re [going paperless] because everyone is doing it that’s a really stupid reason. If you’re doing it because you have a clear business plan of what it’s going to give you and you can reasonably predict your return on investment, it makes sense.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNN-Money.com, Bankrate.com, and Healthy Family magazine. She can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the March 2009 issue of Physicians Practice.