The Path to Paperless

How Paperless Can You Get?

Some paper forms are difficult to eliminate.

By Peter J. Polack, M.D., F.A.C.S.

What exactly do you expect from an EMR solution? What are the key goals you expect to achieve?

Is it to make your practice more efficient? Are you preparing for the eventual future of mandated electronic records? Are you getting ready for "pay-for-performance"? Are you wishing for a truly paperless office? Is this even possible?

One of the challenges we face as we change from a paper-based culture to an electronic one is what to do with the various paper forms which we use in our practice and surgery center — some of which are required by state or federal agencies and others which the practice became accustomed to using over the past 35 years.

We are now putting together a binder to see which forms are mandatory, which contain information that is duplicated on other forms and which are used so infrequently that we can live without them.

Because our goal is to have as much documentation entered within the EMR system as possible, many of these forms must eventually be turned into customized templates that can be filled out electronically. Making this transition is a major project that will consume time and money. We will have to decide which forms we want to incorporate into the EMR system and which ones, such as patient past-medical history, will be filled out manually on paper.

Paper forms will then have to be scanned into the system and saved as images. And the downside to this "scanning solution" is that the data in the documents stored in this manner have very limited use. This is what is know as "read-only" information and cannot be easily accessed for research purposes or data mining. Some practices that run on an EMR system, however, have found that the use of some paper forms is an integral part of their workflow; after they are used they are shredded at the end of the day.

Here's One Paperless Shortcut

One way to reduce paperwork without a full EMR implementation is the use of e-Prescriptions, which are available in some practice management systems. Prescriptions can be sent electronically to the patient's pharmacy without the doctor having to hunt down a prescription pad and manually write out a prescription.

Another issue is communication between medical practitioners, many of whom will not be EMR-ready for the foreseeable future (it is estimated that about 7% to 10% of medical practices now use EMR). Many EMR systems can generate a document based on the clinical exam that can either be printed and snail-mailed or sent electronically by fax to a referring doctor, for example. The legalities of e-mailing medical information have become quite complex and would require a separate, lengthy column for a full discussion.

Even if you can scan all paper documents into an electronic format, you still may not be able to completely eliminate the paper in your office: there are many forms which will need to be kept in a paper format for legal or regulatory purposes. So, don't get rid of your file cabinet just yet. It may be years before we see the day that all documentation can be stored electronically.

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