Why You Should Go Paper-Less

There are several common fears and misconceptions circulating among physicians that downplay the importance of adopting Electronic Health Records (EHRs), and the impact that EHRs can and will have on your practice’s productivity, efficiency, competitive advantage, ability to participate in clinical trials, and overall resale value. If you feel any uneasiness about the effect an EHR might have on your business, take a moment to consider the information provided below.



"EHR's cost too much - I just don't have the cash on hand."

Incentives to help cover the costs of EHR purchase are now available. The HITECH Act (enacted as part of the American Recovery and Reinvestment Act of 2009) authorized federal monies to be set aside for the express purpose of encouraging (and rewarding) physicians and other clinicians who adopt EHRs before 2015, when they are set to become the industry standard. Specifically, the Centers for Medicare & Medicaid Services (CMS) created a regulation to implement that goal, and those programs are called the Medicare and Medicaid EHR Incentive Programs. Physicians interested in the Medicare EHR Incentive can go to the CMS website and register now, although those interested in the Medicaid EHR Incentive Program will have to wait until September 2011 when the Florida Agency for Healthcare Administration is scheduled to open registration. For more information about these incentives, click here.

"I don’t see enough Medicare or Medicaid patients to qualify for the EHR incentives", or "I only see patients with private insurance."

Many PaperFree EHR Vendors offer special pricing deals for our members. Because of the large influx of new vendors into the EHR marketplace, many new and established vendors are offering reduced pricing deals, and PaperFree Florida has negotiated advantage pricing on certain EHR products exclusively for our members. For more information on our qualified vendors, click here.

Some vendors offer financing options that make EHR purchase more affordable. EHR vendors recognize that making a large capital investment all at once may place a great strain on operations, especially for small private practices and solo practitioners. Consequently, some savvy vendors have begun to offer "deferred payment financing," in which the vendor partners with a lender to offer financing with no payment required within the first six-months of installation. Financing options are generally structured with an eye toward allowing providers to receive their first Medicare or Medicaid EHR Incentive payment before any EHR payments are due. For providers who don’t want to purchase the actual EHR software/hardware outright, there is also the option to purchase "software as a service" (SaaS), where the practitioner or practice pays a monthly subscription fee for the EHR software and corresponding technical support services. Each option has potential benefits and drawbacks, but PaperFree Florida can help evaluate your options and select the avenue that best fits your technological and financial needs.

Consider the long-term financial and professional costs of relying on paper records. Regardless of practice size, most practices spend copious amounts of money on paper, toner, and/or other materials that are used to create and maintain paper charts, in addition to the office space that has to be sacrificed to maintain those records and/or the financial costs of storing volumes of paper records offsite. Many practices also incur monthly fees for shredding and/or removal services. Should a piece of paper be misfiled or mislabeled, it might never be found. Moreover, paperwork errors persist and many errors are not caught before serious consequences develop. Whether those errors relate to scripts, information in a patient’s health record, or billing and insurance information, they could have far-reaching and sometimes legal implications that drastically affect your bottom-line. While there is a financial cost associated with EHR purchase (and time costs associated with EHR implementation), the savings in time and physical energy required to run your business are invaluable, and the long-term increases in efficiency, productivity, and enhanced patient care may be the only incentives you need to make EHRs a reality for your practice.

"I'm not computer savvy, so I prefer to keep writing on paper."

Many EHRs have features that allow you to continue aspects of charting on paper. In fact, because some physicians prefer to handwrite their notes, some EHRs have features that allow physicians to scan multi-page documents directly into the patient’s chart. Even if the EHR you ultimately select doesn’t have this capability, you can purchase third-party hardware or software that would allow you to enjoy chart scanning as part of your EHR experience.

Some EHR charts can be configured to look exactly like paper charts, and can be customized to the physician’s needs. The digital chart can also be customized by specialty, and allows providers to select and add key information to the chart template that could inform their diagnoses or treatment plans, such as a list of drug allergies, interactions or past prescriptions. This development makes EHR usage more intuitive for the provider, and allows physicians to gather all information that should be in the patient’s medical record in one central place.

Multiple users can access a single patient’s chart simultaneously. Many EHRs allow physicians, and/or other relevant personnel like Medical Assistants, to view and input chart notes at the same time. In contrast, practices that use paper records must pass around the chart to one person at a time.

The lack of an EHR makes information backup and recovery extremely difficult in the event of severe tropical storms, hurricanes, or some other natural disaster. Paper records cost so much to produce, maintain, and store that many small practices have only one copy of each patient’s medical record. In the event of facility damage due to inclement weather, many physicians are put in an untenable position, especially if existing patients require emergency care or copies of those ruined records during such crises. In this respect, practices with EHRs have a distinct advantage. If their system fails or loses power for some reason, the files are generally available despite the crisis because those files have already been backed up and are stored at an offsite facility (or in a virtual storage repository). Moreover, if one of your patients requires emergency care or care outside of your office, you can easily and electronically transmit the information to the caregiver immediately and without additional work on your part.

"My staff and business associates (such as labs) know how to do business on paper, not EHRS, and they might resist the change."

Most people are resistant to change because they don’t fully understand why the change is happening. A frank conversation with employees that incorporates sharing of their fears with a practice manager and/or physician owner clearly explaining why the change is needed, and what the benefits will be, can allay some of that resistance. Although there is a learning curve during the early stages of the EHR transition process, technical training from vendors coupled with user support from PaperFree Florida can make the process much simpler. Over time, EHRs will significantly improve workflows post-implementation. Moreover, practices can choose to stagger the implementation process and break it up into stages, so that physicians and office personnel can learn the new system while minimizing any interruption to the business of practicing medicine.

Labs, Clearinghouses, and other businesses that commonly interact with medical practices are also making the transition to electronic records. These companies are interested in eliminating errors created by illegible handwriting and minimizing costs associated with paper-based health businesses. Even if the labs or billing companies you currently do business with accept paper-based transactions today, that will soon change. These industries are also preparing themselves for 2015, when EHRs will become the industry standard and they want to be prepared to do business in the modern medical era. The longer you take to transition to EHRs, the likelihood that your practice will fall behind the curve increases.

"I participate in clinical trials using paper records - it doesn't matter if I implement an EHR"

EHRs make it easier to participate in clinical trials, which can increase your return on an EHR investment. The number of licensed physicians participating in clinical trials has historically been very low due to the significant burden that research and data collection place on the staff, financial resources, and the physician’s time, in addition to the other laws and regulations the practice must comply with. In contrast, doctors that implement EHRs can easily adapt their businesses to meet these obligations by making modifications within their system to ensure more accurate and efficient data collection. Since EHRs make clinical trial participation much easier and more likely, physicians stand to gain thousands of dollars in profit every year.

Collecting study data is greatly simplified, and it is much easier to track how data changes over time. It is also easy to select which information should be shared and which information to exclude.

Your ability to participate in future clinical trials may be impaired without an EHR. Once EHRs become the industry standard, pharmaceutical companies, universities and other research entities will increase their expectations for easier data harvesting and analysis. In fact, some sponsors may view EHR implementation and use as a precondition for participation. Eventually these sponsors will no doubt expect a much quicker turnaround for submission of clinical data that can only occur though widespread EHR use. If you depend on clinical trials to make up a percentage of your current revenue, and/or plan for clinical trial participation to generate future revenue, consider the fact that implementing an EHR now will enhance your future ability to recoup some of the costs of implementation and will have a definite impact on your practice’s ability to serve as an attractive clinical trial site.

"I don't have to transition to EHRS - I plan to sell my practice and retire soon"

The resale value of your practice will be significantly reduced if you don’t have an EHR. As the laws are set to change in 2015, doctors have to be savvy about how they invest their money and what factors should influence their decision to purchase another physician’s practice. Because many young doctors know that EHRs are an investment necessary to modernize a practice and bring it into compliance with the law, most reasonable buyers will deduct the cost of purchasing and implementing a new EHR from their offer, leaving physician sellers without EHRs at a competitive disadvantage in the marketplace. Furthermore, doctors who are already familiar with EHRs and/or use them daily will be more attracted to purchase opportunities that feature implemented EHRs, and may even undertake their search with the goal of purchasing a practice that has a specific EHR they are already familiar with. As the national trend of larger organizations buying and absorbing smaller private practices continues, these organizations will be most attracted to practices that already have an EHR, and will have an even stronger incentive to acquire practices that already have the same EHR used by the organization for a seamless change of ownership and transfer of personnel and information.

The lack of an EHR affects physician recruitment. This is another factor that could affect your resale value indirectly, because a potential buyer may be looking to expand the practice and bring on new physicians. Most new physicians have grown up in the technology age and have a very high comfort level using EHRs and incorporating a variety of other health information technology advances into the practice of medicine. This new generation of physicians is excited about working in practices that have a competitive edge on the market and in patient care--and already use an EHR.

The lack of an EHR makes relocating your office extremely difficult. Relocation concerns may also affect the willingness of potential buyers to consider your practice. EHRs make moving your office a breeze—all you have to move is your furniture and electronic hardware; you don’t have to worry about unintentional HIPAA violations if paper records are misplaced, lost or stolen during the moving process, and your office staff would not have to devote any time to re-establishing or reorganizing your paper records system in the new location.

"My patients may not be comfortable with me keeping all of their data in electronic form"

Most patients believe EHRs will help their doctors provide better patient care. Most Americans use advanced technology to complete ordinary, everyday activities such as paying bills, registering for classes, shopping, and the list goes on. As a consequence, those consumers want the delivery of their healthcare to incorporate technology to improve efficiency and quality of care—they want to prescriptions (and refills) to be filled electronically, to receive appointment reminders via email, and be able to communicate with their physicians online.

Most patients do not understand that the HITECH Act strongly modified the HIPAA Privacy & Security Rules so that electronic protected health information (ePHI) remains strictly confidential. If you educate your patients about these strict guidelines, and the fact that EHRs make it more difficult for thieves, hackers, or unauthorized employees to access ePHI and make it easier to track exactly who accessed the record and what information they viewed, these security concerns will diminish markedly or even disappear. HITECH/HIPAA regulations are very strict about who has a right to view ePHI, and affords EHRs a level of protection that is impossible to achieve with paper charts. Physicians cannot even access their patients’ records without a username and password, and can set strict permissions for employees and other personnel authorized to view the information. EHRs will prevent unauthorized persons from accessing or viewing ePHI, and will alert authorized users of any attempted wrong-doing, and make it easy to identify potential culprits.