Removing Paper
Contents
We shouldn't get rid of paper
It will be a LONG time before paper is eliminated so we need to realize this and stop making things harder on people by refusing to print things. The trick is to make useful reports so endusers will clearly see that ENTERING clinical data will make their reports better. In my opinion, the most import thing is to get good data into the system in a timely manner where it is accessible to all including our clinical decision support applications. Good reports can be a means to this end. Then when really good portable devices are available , the paper reports might go away by themselves.
Using Paper can increase system acceptance
One site got residents to use the old TDS system in the early 1990's by providing a printed rounding list that mimicked the one they did by hand. After the implementation of Cerner last year, the administrators (who don't use the system, or even practice medicine) decided to eliminate this and other useful reports. The residents now manually type this report that was once automated and print copies for all at sign out time. Result: no paper savings and great loss of time.
Key Points to Consider
People like to hold onto something so we have taken the "you can still do it" approach, but don't make it easy for them.
Don't forget the patients...
In 1999 at Bellevue Hospital in NY, NY, they began to implement a 'less-paper' primary care clinic. Outpatient lab orders taught them an important lesson: They built electronic orders for CPOE and created new and improved physician, nurse, and laboratory workflows that leveraged the CPOE system. They quickly discovered, however, that patients wanted a paper reminder to have a lab test. Ultimately, they created an outpatient instruction sheet that included tests ordered, consult appointments, and other follow-up care for the patient. The single page form was not required for completing diagnostic tests (the actual orders were electronic) and required less paper than the original printed test orders. In the end, providers, the lab, the finance department, and the patients appreciated the new processes.
