Hospitals that have tried to shed their reliance on paper have found the task fraught with challenges. Some have found that document imaging provides a useful interim step in meeting their goal.
If the ultimate goal for a hospital is to become 100 percent paperless, then document imaging has to be at least an intermediate step in achieving that goal. And for chief information officers who are facing this paperless challenge, scanning paper documents into appropriate information systems has to become an integral part of their overall strategy.
But given the amount of paper still being generated from both inside and outside of hospitals, is this goal achievable? “The concept of a true paperless hospital will never exist,” says Russell Branzell, CIO and vice president of information services at Poudre Valley Health System in Fort Collins, Colo.
For Sue Schade, vice president and CIO of Brigham and Women's Hospital in Boston, Mass., the issue is one of degrees. “Are we ever going to be paperless or just use less paper?” she asks.
Schade says her hospital is in the process of implementing clinical documentation systems for both physicians and nurses that will greatly reduce the amount of paper now being generated on the clinical side. Having already installed separate ambulatory and inpatient electronic health records (EHRs), Brigham and Women's Hospital has put into place a document imaging strategy. “We did this as a bridge strategy until clinical documentation goes online,” she says.
Schade acknowledges there was a second reason for implementing this strategy: the organization's Health Information Management Group and all stored patient records needed to be moved to an offsite facility because of space constraints within the hospital.
In addition to scanning paper documents that are still being generated by clinicians, the hospital scans every patient's chart upon their discharge. “One day after discharge, the scanned documents are available online,” she says.
Document imaging as an interim step in going paperless also has been a successful strategy for CentraState Healthcare System, says Indranil Ganguly, vice president and CIO of the Freehold, N.J.-based provider. Major parts of all inpatient records such as physicians’ progress notes and consent forms are still paper documents that need to get scanned into the EHR, he says. And while all nursing documentation is already being done online, this 282-bed hospital still relies on the traditional paper chart. However, Ganguly notes, “We are totally paperless post-discharge.”
Within 48 hours of discharge, a patient's chart goes to the medical records department where the staff processes the chart, runs the necessary quality control checks, and then scans all paper documents into an EHR. Once that process is completed, the paper charts are destroyed. “We've been doing this about four years,” Ganguly says.
It's somewhat different, though, when a patient is admitted. At that point initial consent forms are captured using an electronic signature pad, he says. Patients transferred from another facility or referring physcian usually bring paper documents with them. Upon admission, all pertinent information from these documents is manually keyed into that patient's EHR.
It's no surprise that these strategies and other efforts to go paperless have created some challenges. The integration of systems is always a major challenge, as is the attempt to change old habits, Ganguly says. Fortunately, physicians have gotten better at checking computers before they get to a patient's room, he says.
THE DIGITAL DIVIDE
Russell Branzell knows how difficult it is to try to eliminate paper from all departments within a hospital and that it may take more than one strategy to achieve a modicum of success. As yet, not all physician documentation is being entered directly into a patient's EHR, and there are still some patients-mainly from rural areas-that bring paper records with them when being referred by a physician practice or other healthcare facility, he says. Nonetheless, Branzell notes that that over the past two years he's seen a significant drop in the amount of paper being generated by, or coming into, Poudre Valley.