Paper records?

[AKAdemic]

Hey,

Looking at jobs and one place has paper records and I've never used them -- grew up with all sorts of different EMRs but never good old pen and paper. EMR is also not coming anytime soon.

Has anyone here worked with paper charts? Would you do it again?

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[wolfvgang22]

Yes. I would go back to paper charts all day every day. The biggest drawback of paper charts for me is that EMRs make it easier to find old notes or records and share those with other clinicians. Typed notes are easier to read.

The downside of EMRs, however, is in their implementation, with ever growing sets of checklists and button clicks and endless data entry to drive analytics and prevent law suits. Various administrators always say "it's just one more button to click" and "it will only take you 20 more seconds! What's the big deal? Don't you care about your patients?" The problem is multiples brief episodes of data entry added up over days and months and years results in a chart, that if printed, would consume all the paper in the known universe for just a single patient, reduces the doctor to a data entry technician, and increases burnout. This massive amount of document generation is simply not feasible due to simple physics in a paper chart. Once a chart is burgeoning with paper and explodes all over the room, notes seem to get shorter while awaiting a new 3 ring binder. Also, it costs the healthcare organization more money to store and transport and safeguard paper charts! So brief notes are more incentivized and tolerated in paper charts.
I haven't noticed patients getting dramatically healthier from endless EMR data entry, either, though I'm certain the EMR industry has probably sponsored some studies showing it does.

 

[hamstergang]

I hate paper charts. So difficult to figure out what was happening before you if there are existing cases (reading notes, finding pages, it's easy on paper to just not fill some things out). More difficult to coordinate with other doctors even in your own system. Writing a lot hurts my hand and takes more time for me than typing. It's harder for me to write notes while with a patient because I don't always get info in the order I need it or stories might change (much easier to edit typing).

However, not every EMR implementation is better. What I have now at my hospital is good, set up in a way to save me time over paper.

 

[futuredo32]

I do paper in my small private practice and the clinic where I work on Thursdays. We dictate at the hospital where I moonlight. The turnaround time for transcription is super slow. I love paper and pencil.

 

[Stagg737]

I did paper charts on a couple psych rotations and actually loved it. It just felt a lot more straight-forward than most of the EMRs I've used and you don't have to deal with scrolling through tabs forever. I don't mind EMRs, but I felt like there were a lot more small things that I had to check off with EMRs that can make them a major hassle. I may also be bitter because the EMR I'm using as a first week intern has been a huge pain and my first few days have been far longer than necessary because of it.

 

[Bartelby]

I have worked with paper charts. I found them to be a huge hassle. The handwriting is often terrible, and you are responsible for deciphering it. You also often had to track down 2-3 separate charts, which often times were on various peoples' desks, before you even got to start thumbing through and squinting to decipher them. I have no regrets about the move to EMR.

Still, the expanded clickboxes, chart cloning, and expectation to document a novella for each patient are major drawbacks of EMRs. There needs to be some kind of balance, because modern EMRs often generate reams of trash text with just a little thought buried somewhere inside.

 

[NickNaylor]

Apart from making notes more easily accessible across a hospital system - and, I suppose, more legible (because I occasionally get records from OSHs that are paper charts, and they are atrocious to read if I can read them at all), but I'm not convinced that EMRs have, on the whole, made my life easier and/or productive.

 

[FlowRate]

It seems to me that this sort of comparison is heavily dependent on your charting habits in each system. Paper charts can be succinct and readable and capture a good amount of data by circling boxes the same way you select items on an epic smartlist. But I'll always be faster and more legible typing or dictating if asked to produce a narrative.

 

[birchswing]

Sometimes I wonder what it'll be like for historians thousands of years from now to deal with digital data. It seems like there is much more data on the one hand, but on the other paper holds up pretty well compared to electronics that break down and have changing formats. In the short-term digital seems much more convenient. In the long-term, not sure if there's a plan for how to archive digital material.

 

[SpongeBob DoctorPants]

Both systems have their benefits and drawbacks. In clinic I love the ease and convenience of renewing prescriptions electronically, and it is easier to review notes of other providers, but I hate how many checkboxes I have to click on and the number of screens I have to navigate through. In the hospital I'm at it is much worse, and it takes me about 10 times as long to generate an electronic progress note compared to paper.

 

[Pomacentridae]

I wonder whether the difference in attitude towards EMR vs paper charts is based on age of the responder/responder's familiarity with computers and typing ability. I loathe paper charts. Once you get used to a decent EMR system like EPIC you can write even detailed notes and finish a visit in a much faster time period than writing a similar note with less information by hand.

My education in medical school during 3rd year clinicals suffered due to paper charts and their illegibility. Seriously, I don't understand how anyone can prefer paper charts. I wonder how many medical errors and lawsuits occurred in the past due to the inefficiencies, disorganization, and lack of easy-to-access records when paper charts used to be the only option. Prior to seeing a new intake, you can review and obtain a comprehensive history of the patient in 5 minutes via EMR especially with options like "Care Everywhere" on EPIC. I remember how on consult services, the team would have to call and clarify recommendations every single day for every patient due to the illegibility of the notes or inability to locate patient charts/patient notes. Morning rounds and reviewing the patient charts would take forever.

 

[SpongeBob DoctorPants]

I wonder whether the difference in attitude towards EMR vs paper charts is based on age of the responder/responder's familiarity with computers and typing ability.

I think that for some this is definitely true, but it's not the only factor. I have enjoyed EMRs in the past, but my current attitude toward them is influenced by how many unnecessary boxes I need to check and uncheck every time I see a patient, on several different pages within a forms window, simply because my employer requires it, and my notes end up getting filled with a bunch of useless information which I would never have to write if it was done on paper. That being said, if I could choose the EMR program and had some say over what information was required in each note, then I would definitely prefer EMR over paper.

 

[Sushirolls]

I've trained with paper and EMR. I've practiced with paper and EMR. I would only suggest paper for a small, private, solo type practice where no one else really will ever read your notes.

Other than that scenario, EMR is the lesser of two evils.
-paper charts people will take your notes out and not put them back - and you get harassed where's your notes?
-paper charts people will miss file your notes after taking them out - and you get harassed where's your notes?
-paper charts will explode once they get too full *pop* and there are now several hundred pages of stuff lying on the unit floor...
-paper charts slowly wear/tear the holes, and now a sheet escapes... some one needs to catch this and put the reinforcers on it. But wait, where are the circle reinforcers?
-paper charts just aren't legible, and if they are, they take so much time to read each persons unique print or cursive. Can younger generations even read cursive anymore?
-paper charts are constricting with their boxes. Need to write more? Will you really get another sheet to label as an addendum?
-Paper charts ... WHERE IS THE CHART? WHO HAS THE CHART?
-paper charts... where are the vitals? were the vitals even done? who has the vitals?
-paper charts, delays in dictation system that can take a day or two. Rounding on patients with notes that are 1-2 days old is frustrating, and takes more time to piece together with looking at the order section and MAR to see if any noteworthy med changes, or nursing notes if any noteworthy events.
-paper charts lead to wrist pain and finger calluses. Then minor things like your pen running out of ink, now your replacement pen for the day is the cheapest basic pen that isn't what your prefer for flow/quality/efficiency of writing.
-paper charts when on call, nurses are slower too, you hear them flipping through page after page when you ask them, hey what meds is this person on? Pure time waste.
-Paper charts also have charting. This really is dependent on the clinician not the charting method. Paper chart docs if dictating can use thier same canned phrase over and over with each patient, and you are left wondering what the heck is going on with this patient really? EMR can have the same effect with cut and paste, or just very anemic templates.
-Paper charts also require extra time to circle back to medical records to sign the verbal or other orders you missed.
-Paper charts FINGER CUTS.
-Paper charts, WHERE ARE THE PATIENT IDENTIFIER STICKERS. They seem to run out and now you can't appropriately label your notes because, ya got no stickers.
-Paper charts, morning treatment team meetings take longer, because don't know their patients, and if they even reach for the charts to appropriately answer questions, it takes more time than an EMR to find the answer.
-Paper charts, it really gets old fast, signing your name, dating it, and timing it on EACH PIECE OF PAPER.
-paper charts, make a mistake? sign / date that too!
-paper charts, can't read your own hand writing.
-paper charts, nurses can't read your own hand writing so they page you (rightly so!) which means more pages
-Paper charts, don't have the miracle of CARE EVERYWHERE like Epic does.