The "Paperless" Office

I've heard the term "ambivalence" defined as the feeling you get watching your mother-in-law drive off a cliff in your new Mercedes. The term also summarizes my initial feelings about my clinic's recent foray into electronic medical records (EMR).

I share my facility with five other general practitioners; each is at a different stage of preparedness for the use of computerized records. If it had been solely up to us, we would still be scrawling semi-legibly onto voluminous paper-filled charts. However, our very enthusiastic office manager, Anne, rallied us into agreeing to take advantage of Nova Scotia's moderately generous incentive plan to go electronic. Our rationale was that sometime over the next five to eight years it would become mandatory anyway, and what the heck, we may as well let the province take some of the cost.

Next thing we knew we were conversing with My Nightingale, the software developer whose product the province had chosen to wean us off our archaic form of record keeping. We soon had our hardware installed, but were strictly forbidden to do anything permanent until our training was completed and our keyboard prowess assessed.

The ease of assimilation of these skills varied depending on the previous level of exposure to computers, with our youngest partner, Bill, jumping right in like a seal into water. Surprisingly, our oldest partner, Stew, who is in his sixties, hustled and got most of his "patient encounters" into digital mode posthaste. Of course his favorite hobby, genealogy, makes a good knowledge of computers almost mandatory. Since I can touch-type reasonably well (my wife says I would have made a wonderful secretary), and have appalling handwriting, I also got right to work, despite my computer semi-literacy. After much effort, most of my patient visits are now displayed in pixels.

Three of my colleagues, however, have been less sanguine about the whole process and have displayed various amounts of resistance to it. So who is right?

Let's have a look at the pros and cons of going "paperless," starting with the cons:

First of all, I will likely be long retired before we are actually paperless. We are a long established clinic, and lack the resources to scan all of the old charts into the computer, so they are going to be around for awhile. Of course, this wouldn't be a problem in a brand new practice …. Many of our confreres are not computerized, so old records and consult letters come in paper form. Even if a patient transfers from another computerized clinic, if it's not the same system, the chart has to be printed. So until everyone is online and using the same system, there will still be paper.

Second, one of the selling points of the computer system is that it's faster. While this may be true in an ideal, super-high-speed, glitchless cyberworld, in this one, even our "high-speed" internet slows down at peak times. It has even been known to … gasp … crash, which, unless you have a much better memory than I, leaves an embarrassing gap in continuity of care.

Third, since scanning all our voluminous old records is not feasible, we have to do patient summaries on the computer, recording things like allergies, medications, surgeries, etc. This represents a huge amount of (unpaid) work, especially if you have an older, established client base. Again, it isn't as much of a problem in a new practice.

Fourth, for hunt-and-peck typists, using a keyboard can be frustrating. It would be wise to learn to touch-type. There are computer programs to teach you this, or you can seek instruction from your children.

Finally, there is a large financial commitment involved for the hardware, software, and licenses. The carrot our province is dangling covers a lot of the initial costs, which would have been steep if we were footing the whole expense ourselves. In addition to set-up, there will be ongoing costs of updating equipment and licensure.

Before feeling too depressed to start, let's look at the pros (and there are some definite benefits):

First of all, you will get tests and radiology reports almost immediately, often before the patient gets home from the lab. Best of all, the reports are not on paper. Like many clinics, we are rapidly running out of places to file charts and reports. Modern practice requires much more follow-up testing for heart disease, diabetes, high blood pressure, and other ailments. We were being drowned in a sea of paper, which has now been cut by about two-thirds.

Second, chart notes are much more legible. If a transcript of chart notes is required for insurance or legal purposes, it's easy to print off, and a translation of our hieroglyphics is not required. I've sent several patients off to the ER with their summaries and my consultation notes which, reportedly, the recipients found most impressive, as well as being a real time-saver (and possibly a life saver in critical situations). One ER doc thought my patient had produced the notes herself and asked if she suffered from an obsessive-compulsive disorder.

Third, once prescriptions are in the database, it's a matter of a couple of clicks to do refills, which really saves time when there are eight or 10 scripts to renew. It's even possible to have the information faxed directly to the local pharmacy. Likewise, lab test and radiology requisitions can be done on the computer. Consult letters are a snap, as the medications and patient's history can be added to the letter with a click.

Finally, we have freed up personnel for other tasks, since there is little dictation, pulling charts, or filing lab reports required.

While I was initially ambivalent, I believe we made the right decision in going to EMRs. EMRs are the wave of the future, and are likely to become mandatory in the not-too-distant future. There were those who clung to carriages when cars first came along, and resisted flying when commercial air travel began, but ultimately efficiency and technology win out. Will you be ready?

Discuss This Article

Have something you'd like to say? Tell us what you think! Read and post comments for this article.

Find a Job

Choose your career:

MedHunters is the world's biggest healthcare job board. Our job directory has 17,875 jobs with 2,484 hospitals and other direct employers.

We want you to find your next job on MedHunters. Need Help? Call us at 1-888-884-8242, email us at info@medhunters.com or sign up now.