Doctors Can't Tear Themselves Away From Paper Records

10 Top Medical Practice Management Software Systems

Even as a growing number of healthcare organizations acquire electronic health records (EHRs), they're not necessarily going paperless. That's the message of a recent online survey of hospitals, physician practices, and other providers by Anoto, a digital pen vendor, whose technology digitizes notations on paper and converts handwriting to text.

Three quarters of the survey respondents said their organizations had EHRs. Yet of the organizations that had EHRs or were currently implementing them, nearly 80% were still using paper records of some kind.

Respondents were asked to comment on how they were using paper. Virginia Carpenter, Anoto's VP of marketing, told InformationWeek Healthcare, "What I'm seeing pretty consistently in their responses are paper charts, physician notes, physician orders, and registration."

How could this be if most of these hospitals, practices, home health agencies, and long-term care facilities have EHRs? One reason is that the definition of "EHR" varies widely. In a recent independent survey of ambulatory care practices, for example, 46% said they had EHRs, but only 26% documented notes in the EHR, used the system for electronic prescribing, and ordered tests or received results in the EHR. Also, as hospitals implement EHRs, physician notes are often the last module to be added.

[ For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch. ]

Even if an organization has retired its paper charts, it still receives a ceaseless flow of incoming faxes and paper documents such as hospital and consultant reports. Staff members often scan these documents into EHRs; in the Anoto poll, 48% of respondents with EHRs said they used scanners to enter some data into the system.

Another survey result shows, however, that paper use declines significantly in organizations with EHRs. When asked "How often are paper forms used (vs. electronic forms) in your organization's daily activities?" 38% said less than a quarter of the time; 36% said between a quarter and half of the time; and the remaining 25% said more than half of the time. Since 75% of respondents said they had EHRs, this finding suggests that organizations with EHRs use much less paper than those without EHRs.

Rosemarie Nelson, a Syracuse, N.Y.-based health IT consultant who works with physician practices, told InformationWeek Healthcare that practices do reduce their reliance on paper when they adopt EHRs. "The use of paper clearly diminishes, but I think people have unrealistic expectations that paper will not exist in their hand anymore. So they think they're still in the paper world, but it's far less paper."

Limitations of EHR systems, inefficient ways of using them, and non-electronic transmission of data from outside sources account for much of the paper use observed in physician offices with EHRs, said Nelson. For example, she noted, practices may not have interfaces with all of their major labs, so lab results are faxed to the practice and staffers must enter the values into the EHR.

If nobody inputs those values, additional paper documents may be generated. In one urology practice, for example, faxed results were scanned into the EHR's document management module as PDFs. A urologist who was seeking past PSA test results for a patient had to open each document in the EHR and jot down the values on a piece of paper, Nelson said.

Imaging tests present another set of problems. In some practices, instead of getting dual monitors to compare sets of EKGs, a doctor will have the old one printed out so he can look at it while he examines the new one on a computer screen. In an oncology practice, Nelson saw a physician viewing a PET scan on a website while he read the accompanying report that the staff had printed out for him.

The good news, she said, is that she rarely sees practices where physicians are using electronic and paper charts together. "In the old days, they used to print a patient summary for that oncologist, and now they don't do that. And he gets on the EHR to write his own order for an MRI. In the old days, he'd walk out and tell somebody else to do it, and he'd have to approve it in his in-box."

Overall, Nelson concluded, medicine is evolving toward a full embrace of digital technology, "but I think we're going to be here with paper for a while."

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