Paperless: Cool But No Cure-all

September 11, 2008

If processes are more efficient on paper, then keep them.

Lately, much is being made about doctors’ offices becoming 100 percent “paperless.” Indeed, many people, including presidential candidates, believe that computerized medical records will solve some major problems endemic in our healthcare system. But while computers are proven helps in the medical setting, simply computerizing the charts in an office does not necessarily improve quality; it may actually make it worse.

Our office has been computerized since 1996. The changeover was so successful that we’ve enjoyed national recognition for the excellent manner in which we applied this technology. Has our success been a result of becoming totally paperless? No. But that was never our goal. Instead, we focused on -- and continue to do so today -- gaining efficiency, not losing paper.

The real benefit of electronic medical records is not creating an electronic equivalent of the paper record. Rather, EMR is a tool by which the entire work flow of processes in the medical office can be re-engineered for maximum efficiency, productivity, and high-quality care. So your goal should be to change the process. Sometimes that involves paper, sometimes it does not.

So many doctors are tempted to rush when implementing an EMR. Resist this urge. Instead, take a step-wise approach that keeps efficiency in mind, not whether the solution is paper or electronic. Then, when you do fire up your new EMR, you’ll already be well-established operationally. Here are the processes I recommend starting with:

  • Interfaces -- Likely, your medical office’s revenue hinges on volume, so your goal should be to make the office visit quicker. Retrieving information is often a bigger source of inefficiency -- and money waste -- than putting it in. Create a single location for all incoming documents. Have labs, X-rays, and consult notes come into the system so users have a reliable place to find information. This involves both electronic interfaces and scanning solutions.

     
  • Medication management -- Refill prescriptions using your computers. It’s much easier and faster with fewer errors, as medication interactions are routinely checked and medication lists are kept much more accurately using computers.

 

 

  • Phone calls -- Make sure that staffers who need it have immediate access to charts. This allows questions to be answered much quicker and documented immediately. We have even worked specific protocols for certain conditions so nurses can answer some questions without consulting physicians.

 

 

  • Intra-office communication -- No more sticky-notes. Rather, after check-in, an electronic “flag” is sent that automatically opens the patient’s chart.

Remember, the goal is to be efficient, not paperless. If processes are more efficient on paper, then keep them. Allow the providers and staff to enjoy the benefits of EMR before requiring major changes in behavior. This results in a much higher buy-in by physicians and a willingness to take the more difficult steps in the future. Also, increasing revenue and getting people home earlier will do much to make the argument that the future is (mostly) paperless.

 

Robert Lamberts, MD, is a primary care physician with Evans Medical Group in Evans, Ga. He is board certified in internal medicine and pediatrics, and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative medicine, attention deficit disorder, and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at rlamberts@EvansMedicalGroup.com.