Many practices plan to free themselves from paper records forever, then end up using EHR and paper together as they encounter problems.
Paper records may cause problems for your practice, but they still present a certain degree of flexibility that software cannot replace just yet.
Unfortunately, using paper as a workaround often negates the benefits of EHR use. Patient data is more readily retrieved, transmitted, and used in electronic form. Paper records can also be more difficult to analyze for trends and patterns. Other disadvantages of paper persist whenever paper workarounds exist, so reducing paper use may be beneficial for your clinic’s operations.¹
Why you’re using paper
Paper use increases whenever clinicians and office employees become frustrated by software or encounter EHR features that are inferior to paper in some way. If the software is difficult to use or is inflexible, users may be tempted to attach paper records to patient files instead of working within the EHR.¹
One article in the Journal of the American Medical Informatics Association offers reasons why many healthcare providers adopt paper and other workarounds, including:²
- Increased efficiency: Regardless of the actual benefits, paper may appear to be more efficient than software.
- Reminders: Paper may serve as a tangible, direct reminder of information recorded electronically.
- Notifications: Paper notifications can be left in work areas to make a coworker aware of new information.
- Training and Teaching: When new information is being taught, some employees reach for paper.
- Mistrust of EHR: For some people and some circumstances, paper seems more trustworthy than software.
- Easier option: Paper may be easier to use or may present options that are not available electronically.
- Customization or Data organization: Paper may be easier to customize or record and present data differently.
- Tangible: Paper can be seen, felt, and carried by the user.
Ultimately, the solutions may require changes to employee training or software functionality. Providing adequate training is often easier to accomplish than modifying software or switching vendors. If you or your employees are using workarounds frequently, you may need to invest in additional training on using EHR properly.²
Using paper properly
Paper can actually be used alongside EHR. This should, however, be a last resort and should be standardized throughout your practice. Before using paper and EHR together, carefully consider the implications of adding paper records. Consider additional EHR training and see if you can address the problem without adding paper. Looking at the above list of reasons for paper use, see if any apply to your office. By identifying the reasons your office is using paper, you may be able to find a solution within your EHR.
The federal government’s HealthIT.gov website recommends that practices develop standardized paper-based workarounds if they determine that using paper alongside EHR is beneficial. If you create standard, paper-based procedures using this strategy, the combination of EHR and paper may be more efficient than using paper inconsistently. Even if you or your employees simply prefer paper, you may be able to adopt paper records for some uses. All paper-based processes should be described and officially accepted by your office as a policy, so inconsistencies can be avoided.¹
Keep in mind that paper records present their own problems. Just like with electronic records, you are required to protect patient privacy and manage patient records properly. If you are adding paper records, you may want to review HIPAA requirements for managing paper.
¹HealthIT.gov. “Example 7: Paper Persistence After EHR Implementation.” https://www.healthit.gov/unintended-consequences/content/example-7-paper-persistence-after-ehr-implementation.html. Accessed June 2016.
²Flanagan ME, Saleem JJ, Militello LG, et al. “Paper- and computer-based workarounds to electronic health record use at three benchmark institutions.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715348/pdf/amiajnl-2012-000982.pdf. Journal of the American Medical Informatics Association. Published March 2013. Accessed June 2016.