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In EHR Era, Medical Practices Still Drowning in Paper Records


When it comes to efficiency, if an EHR is a modern refrigerator / freezer, then paper records are akin to keeping a box filled with a big block of ice to keep foods fresh.

Suppose you walked up to a car rental counter, and instead of all your information going into a computer, you or the rental agent wrote it down, then stuck it in a paper folder. You likely would move down the line to the next rental company.

As antiquated as that may sound, that is still what most patients face when they check in at a hospital or doctor’s office today. Despite the explosive growth in technology, where we can watch streaming movies on the Internet, access e-mail, and bank on a smartphone, our healthcare system is still mired in a sea of paper charting and medical records.

A recent American Hospital Association survey found that less than one-third of our nations’ primary-care doctors’ offices now have a functional EHR. In fact, in 2010 another survey found that only 10 percent of office-based doctors had a fully functional EHR system.

The statistics for hospitals is even worse. According to a report released in 2009 by the New England Journal of Medicine, just 1.5 percent of nonfederal hospitals in the United States use what was referred to as a "comprehensive" EHR system, meaning no paper chart –– at all.

My cardiology practice went to a comprehensive EHR in 2004, yet we still produce lots of paper. If I order a blood test from a lab, or x-ray from a local hospital, their computer systems usually do not “talk” with ours, and hence paper is generated. However, our office system is quite efficient compared to most hospitals, where multiple healthcare providers, from doctors to nurses to secretaries and physical therapists, all vie for possession of a thick binder, where orders and notes and test results about one patient reside. The efficiency of this system versus an EHR, where everyone can simultaneously access vital medical information, is akin to a box filled with a large block of ice to keep foods fresh and cool versus a modern refrigerator and freezer.

Consumer surveys showed most Americans favor an EHR; however they are appropriately concerned about the privacy of their health information as well. I think these obstacles can be overcome. However, there has to be a high motivation between patients, physicians, insurance companies, and hospitals, to succeed. In a few weeks I will try and offer my suggestions about how this might come about.

Until then, I will spend most days drowning in paperwork and fighting a physical therapist, secretary, or other doctor over possession of a paper hospital chart.

Find out more about David Mokotoff and our other Practice Notes bloggers.

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