During the recent HIMSS conference, Travis Boone,  a CMS special assistant, articulated something that has crossed my mind many times. He said: “Meaningful use is the reason we’re interested in EHRs. We’re not in this to save trees.” Actually, the term “paperless” is troubling as it has taken on exaggerated “Holy Grail” importance when, in reality, the end- goal should be creating a digital care environment that truly improves clinical processes and care delivery.  

While I’m as environmentally conscious and practical as the next person, I strongly agree and believe that clinical decision-making, patient safety and the operational benefits associated with EHRs should be what motivates providers to move away from a paper environment, not the mistaken notion that real success is measured by the absence of every last shred of paper.

That’s precisely why it’s critical to consider a “Big-Bang” approach to EHR implementation and adoption. Taking a phased-in approach will not bring the real clinical and financial benefits that each health care provider, and our overall health care industry, needs to get from the transition to electronic systems. A phased-in approach naturally leaves paper behind to support clinical processes, and that crutch will slow long-term adoption of EHRs.

Here’s why: When hospitals implement EHRs in stages, they are often left to deliver clinical care in a dual or hybrid environment. That is, both paper and electronic processes are in play. It’s inefficient at best and potentially dangerous at worst. With such an environment in place, physicians are constantly toggling between electronic and paper sources to find information. As such, they are wasting time, becoming frustrated – and ultimately getting more and more discouraged with the whole move toward EHRs.

One of the strongest motivators for physicians and other clinicians to adopt EHRs is the fact that the data is entered electronically and then accessed online.  The end result: important, up-to-date, relevant clinical information is available anywhere, anytime. With paper records, potentially life-saving information is often hard to come by, and clinicians, therefore, can’t make timely or fully informed care decisions. 

Equally troubling is the fact that a hybrid system has the potential to degrade the quality of care and outcomes. How so? In a hybrid system, the physician is often interrupted while making rounds because data needed at the bedside doesn’t reside in the EHR but in the paper chart, which is back at the nurse’s station. This all-too-common situation requires backtracking to the nursing station and the inevitable search for the chart, which can’t be found because another provider is using it; resulting in confusion and delays in order communication and timely patient care. Worse yet, with hybrid records, clinicians might assume that all of the needed information is included in the electronic record – while vital paper-based data might be missed.

To avoid such scenarios, health care organizations need to take the position that they WILL NOT, for the sake of convenience, print clinical data if it’s already available electronically. As such, organizations will not provide clinicians with a crutch that enables them to avoid full engagement with the electronic system. When the crutch is removed clinical transformation is allowed to progress, and the resulting operational and clinical efficiencies become readily apparent.

With such comprehensive anti-printing strategies and policies in place, instead of constantly breaking down paper processes one-by-one and replacing each with an electronic process, organizations transition to electronic processes all at once.  It might hurt a lot at first--similar to ripping a Band-Aid off—but the pain dissipates much more quickly if done quickly rather than slowly. While all of this may sound so fundamental to not be worthy of this blog space, let me assure you that if it were not for a relentless commitment to the message of  “solve operational clinical processes problems without paper,” many of my clients would have defaulted to a paper-based solution rather than an electronic one.  Old habits die hard and paper has always been the easy answer.

With this all-at-once transition to electronic records, hospitals can move on to enjoy the benefits. To start, it’s much more efficient for physicians and other clinicians to complete chart documentation and to find clinical information when working in an all-electronic system. Complying with HIPAA requirements also becomes much easier when all data resides in electronic form, making it possible to track who has accessed the chart and comply with reporting requirements.  And, health care organizations can save money by eliminating the inefficiencies associated with paper processes and reducing overall supply costs.

What’s more important, however, is the fact that electronic records enable providers to move toward improving patient care and safety through eliminating legibility issues and reducing mistakes resulting from transcription errors. The simple fact that clinical information is readily available at the point of service helps to improve care. Add in the fact that many electronic systems can provide clinical alerts and easy access to clinical research and best practice information and you’ve got a tool that really supports physician activities and clinical decision-making.

In the final analysis, it’s easy to see why it’s so important to take an all-out approach when adopting electronic records--as the clinical and operational benefits bode well for our health care industry. On second thought, though, while environmental concerns shouldn’t drive EHR initiatives, as long as we’re at it, there’s certainly nothing wrong with saving a few more trees.

Becky Quammen is the CEO at Quammen Health Care Consultants. During her 25-year career in health I.T. she’s held senior management positions at large provider organizations and a major health care software vendor. She can be reached at becky@quammengroup.com.


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