EHRs Haven’t Necessarily Reduced Paper (Yet), And What Needs to Be Done About It

Guest post by Chris Click, senior healthcare solutions manager, Nuance (Imaging Division).

Chris Click
Chris Click

Many hospitals and healthcare organizations say they’re committed to moving to a paperless or paper-light environment. Greater document digitization is key to a more seamless flow of information within the healthcare enterprise, increasing worker productivity and reducing costs while also enhancing patient data security and ultimately improving quality of care.

Electronic health records (EHRs) are viewed as a foundational component of this strategy. In 2016, more than 95 percent of all eligible and critical access hospitals demonstrated meaningful use of certified health IT including EHRs, according to Health IT Dashboard. The conventional wisdom would lead some to expect subsequent decline in paper usage, but quite the opposite is happening.

Studies have shown that despite the growing adoption of EHRs and other digital technologies, paper in the healthcare enterprise remains prevalent – and is even growing. Experts say hospitals are seeing as much as an 11 percent increase in their annual print volumes driven by the Meaningful Use program, the Affordable Care Act, ICD-10, and the adoption of electronic record-keeping.

Why is this happening? Sometimes we find that physicians to not yet fully trust EHRs. Approximately 27 percent of a doctor’s time is spent with patients, the rest being spent on office work, documentation and EHRs – a common source of physician frustration. Also, disjointed processes of gathering paper-based information from a variety of points within a facility lead to delays in uploading this information to the EHR – leading to physicians keeping copies of patient files on hand.

EHRs alone are not enough to decrease the mountains of paper in hospitals and healthcare facilities. Organizations should consider augmenting EHRs with the following capabilities:

Integrated Document Workflows

Even healthcare organizations that have achieved late-stage meaningful use continue to print and process high volumes of paper for assorted reasons – from patient admissions and discharge, to belongings and consent forms, to prescriptions and pharmacy records. The benefits of EHRs can only be achieved insofar as they are integrated with digitally-based document workflows – the series of electronic steps by which a process is executed.

Consider physicians submitting prescriptions to pharmacies. When the EHR is directly integrated into this process, it can be automatically flagged if the patient is on another medication or has an existing condition which could cause an adverse reaction. If the EHR is not integrated, the entire process is disjointed and not as seamless and safe as possible. Or, consider the discharge process – when the EHR is integrated, discharging physicians have immediate access to patient files and charts – negating the need to print this information. Furthermore, studies show that “hybrid” paper-electronic workflows are ripe for error.

Numerous outpatient and clinical departments can create challenges for documenting a patient’s complete history. Patients arrive at the clinic or hospital with a variety of paperwork: insurance, medical history, referrals, on-scene accident and in-route treatment documentation, all of which must be uploaded the EHR. New workflows enable more direct document consolidation within the EHR, helping reduce manual reconciliation and increase time spent with patients.

Multi-function Printer Controls

In some instances clinicians still prefer paper, which can contribute to its extended life within healthcare organizations. While digital communication is often ideal for shorter correspondence, people tend to be more adept at reading and absorbing lengthier content on paper – leading to more printing.

Just as organizations have taken stringent cybersecurity measures to protect digital EHRs and other sensitive patient information to remain HIPAA compliant, they must take similar measures to protect paper-based information. The multi-function printer (MFP) is one seemingly innocent piece of office equipment where patient data confidentiality lapses are far too common.

Consider a physician printing a document to the wrong printer or forgetting about a printed document and accidentally leaving it in a paper tray – putting patients’ protected health information (PHI) at risk. There are simple controls available to help improve the security of paper generated through MFPs, including “follow-me printing,” which holds documents in a secure print queue until the user authenticates themselves at any network MFP. Organizations can better safeguard PHI residing in paper documents by requiring user authentication before printing and accounting for all output activity with an audit trail.

Most MFPs offer capabilities extending far beyond printing, including scanning in bulk which enables patient data to be digitized and uploaded into EHRs and other digital files. However, scanning can create a security blind spot. For example, an unauthorized user could scan and send documents to a non-sanctioned location such as a personal email address. Other popular MFP functions such as scanning, emailing and faxing should be carefully monitored like printing, requiring authentication prior to scanning or faxing and creating an audit trail that tracks who scans and faxes what documents and the destination of files.

Holistic Approach to Paperless

EHRs alone have not proven sufficient in creating a paperless nirvana of highly productive, secure information flows driving maximum patient care excellence. The healthcare industry’s paper problem may be bigger than anticipated, and will require added measures for it to be overcome – if being completely paperless is even a realistic goal. IDC notes that while 40 percent of healthcare organizations currently have paper-reduction initiatives in place, print volumes are likely to remain at their status quo over the next few years, before any signs of a decline will be seen.

No healthcare organization should expect immediate magic upon an EHR implementation. Evolving to a paperless or a paper-light operation will likely take several years or more, for even the most sophisticated EHR adopters. Augmenting EHR strategies with better integration into healthcare workflows and stronger MFP controls will be critical to EHRs achieving their full paper-reducing potential.

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