Monday, August 5, 2013

Is There a Place for Paper Documentation?

The first question is whether any urgent care, medical office, and/or emergency department can really survive totally without paper.  Second question is whether the documentation portion of the medical record can still be done on paper, and whether it could then serve to support patient care in a manner equally, or perhaps more, effectively than electronic documentation.  These are complex questions, but many are coming to realize that paper may still have a role in modern medicine.

In practices or institutions not quite ready for a full-blown electronic health record, paper can be a very effective part of the workflow.  Well-structured paper charting,  integrated with modest and simple electronic tools (scanning, e-prescribing, patient education and follow-up) can be a beneficial and legitimate solution to the EHR documentation quagmire.

Some benefits-
  1. Predicable provider acceptance and willingness to cooperate- this is a key component for the success of any clinical system.
  2. Storing and retrieving patient records becomes simple by scanning all documents to the patient database.
  3. Prescriptions are quick, managed, and legible.
  4. Patient education and follow-up instructions are legible and rapidly produced.
  5. The need for provider-financed documentation assistants- scribes- virtually disappears, saving $$$!
  6. Template documentation facilitates completeness, and is valuable for medical-legal and financial reasons.  Free-handwriting should be used only to supplement a template, but not to document the entire encounter.
  7. The costs of paper solutions are historically much less than those of EHR implementation and maintenance.
Negatives do exist-
  1. Legibility issues
  2. Potential losses of meaningful use stimulus money.  However, meaningful use criteria is a constantly moving target that many- despite huge expenses for EHR systems- have not received.
  3. Decreased ability to extract data.
  4. Common traditional complaints about paper templates- legibility ad difficulty obtaining a representative narrative.
Paper documentation can be realistic for practices that can structure themselves to be partially electronic.  If you are so inclined, choose a product that has a good database, a scanning solution, and well-written templates.  You may want to implement a system that uses voice-activated EHR technology for certain type of cases.  When the next- future - quantum advance in EHR technology is available to clinicians, it may - if simple and easy to use- actually take us beyond paper.  At the moment, however; that future isn't here yet.

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