Does Going EHR Really Mean Paperless?

By Chuck Wright

You have heard it many times from salesmen and probably even said yourself, “We are going paperless!” But are you really? Those savvy salesmen made it sound like you would be saving the environment and your wallet by switching to an Electronic Health Record (EHR) system.  In some instances you may actually use more paper.

Copier companies who service and sell medical office machines have seen increased revenues when doctors make the switch.  With over 50 popular EHR software systems out there the odds of another office having the same system is slim.  The best way to have another doctor review something is to print it.  Laser printers continually run in the background as reports, prescriptions, back-up copies, file transfers and other things are printed.

It is true that eventually you won’t have to use charts but many offices still keep them around.  Offices that have been accustomed to using charts in the past are reluctant to completely stop using them.  Over half of the doctors who switch to EHR still use charts until they are satisfied the new system fills the needs of the office.  Some offices even use both systems in a form of redundancy to ensure no mistakes are made.  Other offices have made the major investment to put the system in place and be compliant only to go back to the way that works best for them.

Most doctors would rather interview the patient their way instead of filling in the boxes that the software system dictates.  This allows them to focus on the patient instead of the computer screen.  The resulting interaction results in old fashioned paper notes being taken and then transferred into the system afterwards.  What do you think the doctors do with their notes?  You guessed it, put it in a chart because it is easier than scanning it.  Other items go back into the chart as well…outside labs, referring doctors, and other services that arrive in a hard copy format make it back to a chart.  The only way to get these items into a system is to spend valuable time and resources to scan or re-enter the information.  That is why in so many electronic patient files you see the message “Refer to Paper Chart”.

There is also the inevitable fear of the computer system going down.  How many times have you had to reboot your computer system and reconnect all the devices on the network?  Hopefully you are able to fix it quickly without having to call in your IT personnel.  The problem is that even a quick fix cause delays in a busy day of scheduling patients.  You can’t just send your sick patients home because your system isn’t working properly…you have to go back to the old tried and true method of paper.  Keeping enough supplies of the old system around ensures your ability to have a back-up system when all else fails.

Don’t Fire Your Printing Company – The EHR system only streamlines the health records in your practice, it does not stop the other paperwork in the office.  You are still going to be calling your local printer for a vast array of items.  The forms that have made your office run efficiently will still need to be ordered.  There still are going to be letters sent out on your company’s letterhead and put into an envelope.  Business cards are still needed for you to interact with others. Thank you cards should be used for referrals, and so on.

Paper products will still be used for your accounting services as well.  A printer who specializes in medical items will be your best resource for checks, specialty billing and insurance forms, invoices and other items needed for proper accounting and billing.  Even if your EHR system has billing features included special supplied laser forms may be required for the system to print on.

Patients Need Paper Products – Try sending your patient home after having a procedure done with a disk that has electronic follow up instructions on it…It just won’t work.  You are going to have to send them home with paper work.  Doctors who do routine procedures have preprinted instruction sheets ready for their patients to take with them.  This saves precious time and resources by not having to wait in line for the laser printer to print.

When the patient needs to get a prescription filled this typically is on paper as well.  While some EHR systems are set up to send an electronic prescription to the pharmacist, you would have to know to which pharmacy to send it and if they are capable of receiving it electronically.  Most doctors just use the old reliable paper prescription and let the patient decide where they want to have it filled.  The State of Florida requires that controlled substances, Medicaid and certain prescriptions be written on tamper proof prescriptions provided by a state approved printer.  Again, this is where it is good to have a printer who specializes in medical printing needs. They can answer all the questions about prescriptions and even provide approved laser sheets on which your system can print.

Patients also need HIPPA compliant sign-in sheets, appointment cards and like brochures or other printed materials that explain other services your office has to offer.

So, next time someone says, “We are going paperless” just imagine how your office would run without it.  And for that misnomer about being environmentally friendly by not using paper just think about this for a minute.  Paper is not made from knocking down trees in rain forests; the trees from where we get our paper are grown by American farmers in crops just like wheat and corn. Paper is typically made from the discarded parts of the tree that can’t be used for building products.  Paper is the only thing that your office uses that is truly biodegradable…the same can’t be said for the computers and disks that hold the electronic data.

Chuck Wright is the owner of the printing companies, TWI Services, Inc and the president of the information group, Medical Office Resources of Florida, LLP.  He can be reached at