'Samantha Brown points out that, “Healthcare, like every other industry, gets caught up in the idolatry of the ‘innovators.’”' I…
Readers Write: EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?
EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?
By Chris Click
Chris Click is senior healthcare solutions manager of document imaging for Nuance of Burlington, MA.
EHRs have numerous advantages. Foremost among them, patients’ health records are readily available and stored securely. Despite these benefits, hospitals report an 11 percent increase in paper usage, driven by Meaningful Use, the Affordable Care Act, ICD-10, and the adoption of electronic record-keeping. This begs the question — why is paper usage increasing as hospitals adopt EHRs?
According to Health IT Dashboard, in 2016, more than 95 percent of all eligible and critical access hospitals demonstrated Meaningful Use of certified health IT, including EHRs. Unfortunately, doctors are not always happy or comfortable with this widespread adoption of health IT. Physicians Practice’s 2017 Technology Survey found nearly 43 percent of physicians cited issues with their facility’s EHR as the most pressing IT-related concern. In the same survey, about 75 percent of respondents agreed that health IT is failing because doctors generally do not like the technology available to them.
Physicians’ dissatisfaction with their facilities’ EHR systems lead them to print out patient records rather than work from the device’s screen. Evidence points to this being the case; according to one recent US survey, 88 percent of respondents said they understood, retained, and used information better when they read general documents on paper as opposed to on electronic devices.
Things do not have to be this way. Healthcare organizations need to supply their medical staff with tools to make EHRs easier to use and eliminate unnecessary printing and paper-based records in general, while also maintaining a high level of patient convenience and satisfaction.
Paper is still prevalent in healthcare facilities. Not only because doctors seem to prefer it over EHRs, but because patients often arrive with a variety of paperwork: admission forms, consent forms, pharmaceutical records, referrals, and insurance forms. EHRs can store all this information, but manually entering the information can be an onerous task that leaves patients waiting. Therefore, it’s necessary for healthcare facilities to equip their staff with tools to streamline the intake process and automatically input patients’ information into their EHRs. Installing optical character recognition (OCR) technology onto office scanners and integrating the device to the facility’s EHR will enable administrative staff to scan documents and have the information automatically uploaded into the EHR, saving time for both staff and patients.
Doctors are also spending more time with EHRs and less time with patients. A 2016 study in the Annals of Internal Medicine found that nearly 49 percent of doctors’ time was spent on EHRs (updating them, inputting notes, etc.) while just 27 percent was spent with patients in direct clinical engagement. Giving doctors tools to make recordkeeping easier will give them more time to interact with patients.
Hospitals should consider giving their medical staff voice recognition or OCR tools. Both have become practical alternatives to typing and are a much faster, simpler way to transcribe doctors’ notes into EHR systems. A recent study showed that voice recognition software is faster and more accurate than typing, and OCR technology, when paired with document scanners, can convert paper documentation such as patient reports and clinical tests into searchable content for immediate use by the clinician in the EHR.
When EHRs are updated more promptly and accurately, physicians’ confidence levels in them will increase. If physicians know that inputting notes will be significantly easier than in the past, this will encourage them to reduce their reliance on paper and instead leverage more modern, convenient techniques. All of this will help reduce the volume of paper and printing.
Healthcare facilities that do not set parameters at the printer leave open the possibility of staff abusing printing privileges and disregarding resource consumption. Equipping multifunction printers (MFPs) with software that creates an audit trail of print jobs can help healthcare facilities manage costs and resources by allowing them to see who is printing and the associated volumes.
In addition to reducing paper volumes and costs, printers can also ensure a higher level of security for sensitive data residing in paper documents. There is software available that enables including “follow-me printing,” which holds documents in a secure print queue until the user authenticates themselves at any network MFP. This ensures that only privileged users can print certain documents and offers better safeguards PHI residing in paper documents by eliminating the scenario of sensitive documents being left unattended on the printer tray.
The healthcare industry’s paper problem can be solved, but reaching Meaningful Use alone hasn’t done the trick. Transitioning to a paper-light operation will require supporting technologies to augment the benefits of a facility’s EHR while at the same time installing better tools to help both physicians and administrative staff streamline processes and while also keeping sensitive, confidential patient data secure.
My eye doctor is a great example of what you’re talking about. He has an EMR, but does not use it. He has an assistant who is basically a scribe and dictates his hand-written notes to the assistant. When you walk in the office, the first thing you see are shelves full of paper charts.
My experience working with practices to convert paper records to digital or records from one EMR to another supports most of what you said.
Having said that, I don’t understand how you think OCR is going to solve problems. Most admission forms are filled out by hand by the patient. OCR software does a poor job of recognizing hand-written information and more time will be spent correcting the results than just typing in the information. A better solution (and I have no skin in this game) is to have the patient complete the information electronically, whether that’s through a secure portal at home before their visit, on a tablet when they arrive, or at a kiosk.
A significant problem that I’ve encountered is that many smaller practices and physicians don’t make plans for what they will do with their paper records when they retire. Regulations vary from state to state, but they are often responsible for maintaining and providing access to patient records for 10 years from the last patient visit and i some cases up to 25 years or more for minor patients. Storing large volumes of paper records for that amount of time is fraught with risk and expense and the records may outlive the physician and become a burden for his or her family.