Overtime, electronic medical record (EMR) systems have unfortunately
become incorrectly identified with paperless systems. In a presentation at the
2010 Annual Meeting of the American Academy of Orthopedic Surgeons, Emily
Brand, BA, a medical student at the University of Louisville presented research
she and her colleagues conducted at a four-physician orthopedic practice that
revealed an increase in paper usage following the adoption of an EMR system.
In the study of these practices, Brand explained that their findings
were classified as business office and administrative paper usage. They further
categorized their findings into specific usage groups. They compared data from
two 1-year periods. The first year recorded usage before EMR and the second
recorded usage once EMR was implemented. Brand told O&P Business
News that a 6-month acclimation period was observed between data cycles.
Findings suggest that EMR systems do not reduce paper usage and, in
fact, actually increase usage. The first data cycle saw a 294 sheets-per-day
usage of paper while the data collected post EMR implementation resulted in a
jump to 818 sheets-per-day.
“Following EMR implementation, there was still an 89% increase in
paper use,” Brand said. “We hypothesize that this was due to a number
of factors including more ways to correlate information, which was then printed
for patient or office use, inconsistencies between technologies requiring
printing of faxed documents to then be scanned into the system and cultural
dependence on the printed page.”
As part of the research, Brand and colleagues also determined where
there were disparate amounts of paper being used and made suggestions for
reduction in these areas.
“Part of the paper issue is a systems problem,” Brand said.
“Documents that we receive via fax, for instance, are then scanned into
our EMR. As health systems become more interoperable … the potential to
reduce resource use is much greater with a digital system.”
Brand explained that their research is not intended to discourage
practitioners who are moving to the EMR system.
“We are trying to address one of the unintended consequences of
adaptation of new technology. It is clear that monitoring and adjusting the use
of paper is an effective strategy for reducing paper use,” Brand said.
“We believe the most acclimated offices will have ongoing surveillance of
how resources are being utilized and will periodically evaluate to ensure that
the most effective methods are being utilized.” — by Jennifer
The study by Brand indicates that, at least in the orthopedic example,
the potential to increase paper usage is possible. It appears that practices
that need to print documents in order to scan them into the EMR will increase
paper use. As well, offices that have significant cultural dependence on paper
may increase paper as they become acclimated to viewing data electronically.
Brand states that inconsistencies in technology can cause an increase in
paper use. An O&P example of this situation could arise from technology
such as computer-aided designs (CAD). Specifically, one may capture a limb
shape in CAD that is not compatible with new EMR software when trying to save
the file in the patient’s digital record. A worst case scenario would
require printing of data for a re-scan into the new software.
O&P practices should not generally imply that that converting to EMR
or paperless systems will actually increase paper usage. However, Brand
reinforces the need for careful planning with regard to purchasing a new
system. The overall goals with EMR and paperless systems includes greater
office efficiency, better organization for care, and an overall, long-term
decrease in administrative costs.
— Jonathan Naft, CPO, LPO
Rehabilitation Engineering and member, O&P Business News
Practitioner Advisory Council