Research Paper: Effects of Scanning and Eliminating Paper-based Medical Records on Hospital Physicians' Clinical Work Practice

OBJECTIVE It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. DESIGN Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. MEASUREMENTS The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. RESULTS The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. CONCLUSION Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

[1]  R F Beckley,et al.  Clinical computing in a teaching hospital. , 1985, The New England journal of medicine.

[2]  H. Lærum,et al.  Doctors' use of electronic medical records systems in hospitals: cross sectional survey , 2001, BMJ : British Medical Journal.

[3]  William J. Doll,et al.  The measurement of end-user computing satisfaction: theoretical and methodological issues , 1991 .

[4]  Massengill Sp.  Image-based document management systems for medical records. , 1992 .

[5]  Ronald E. Rice,et al.  Social worlds, individual differences, and implementation: Predicting attitudes toward a medical information system , 1991, Inf. Manag..

[6]  S P Massengill.  Image-based document management systems for medical records. , 1992, Topics in health record management.

[7]  Tim Benson.  Why British GPs use computers and hospital doctors do not , 2001, AMIA.

[8]  C. Sicotte,et al.  The Computer Based Patient Record: A Strategic Issue in Process Innovation , 1998, Journal of Medical Systems.

[9]  David W. Bates,et al.  Case Report: The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites , 2003, J. Am. Medical Informatics Assoc..

[10]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[11]  Jeremy C Wyatt,et al.  Opportunities for and challenges of computerisation , 1998, The Lancet.

[12]  Marc Berg,et al.  Implementing information systems in health care organizations: myths and challenges , 2001, Int. J. Medical Informatics.

[13]  Charles P. Friedman,et al.  Evaluation Methods in Medical Informatics , 1997, Computers and Medicine.

[14]  T. Norris.  The Computer-Based Patient Record: An Essential Technology for Health Care. Revised Edition , 1998, The Journal of the American Board of Family Medicine.

[15]  Davis Mw,et al.  Reaping the benefits of electronic medical record systems. , 1993 .

[16]  Tim Benson,et al.  Why general practitioners use computers and hospital doctors do not—Part 2: scalability , 2002, BMJ : British Medical Journal.

[17]  R. Hanka,et al.  Evaluating information technology in health care: barriers and challenges , 1998, BMJ.

[18]  Charles P. Friedman,et al.  Challenges of Evaluation in Medical Informatics , 1997 .

[19]  M W Davis.  Reaping the benefits of electronic medical record systems. , 1993, Healthcare financial management : journal of the Healthcare Financial Management Association.

[20]  T. Massaro.  Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior , 1993, Academic medicine : journal of the Association of American Medical Colleges.