From paper to electronic and in between

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EHRs are costly, require wide-ranging cultural change, and have high failure rate. As a result, many healthcare facilities have part paper, part electronic records, or hybrid records. At an educational session during AHIMA 2006, Linda Reino discussed the current state of hybrid records. Reino was CIO of Universal Health Services but recently was appointed as chief operating officer of Medquist.

Hybrid records exist primarily because of budgetary concerns, Reino said. The healthcare industry has a lower IT budget -- most organizations spend 2.5 percent to 4 percent of their revenue on IT compared with 7 percent to 10 percent for the banking industry and 5 percent to 7 percent for manufacturing.

Another reason for hybrid records is that there is no clear, one-stop shop for electronic systems, she said. “Clinical application development is fragmented.”

A lack of standards also drives hybrid record systems. Patient documentation is largely subjective and not codified in a standardized fashion, which means that documentation requires significant data entry.

Rather than waiting for further developments on the electronic records front, many facilities are moving forward with a hybrid system. “Three years ago, people were waiting for things to be perfect,” said Reino. “We need to accept that the industry isn’t taking us where we want to go as quickly as we want to go there. We need to take it one piece at a time.”

The paper chart will be around for a while, she said. It takes a significant investment to replace all paper. And the cultural change required for clinicians to discontinue paper documentation and move to electronic capture of information is significant.

However, value can be achieved now, Reino said. “Even a partially automated patient record can provide pockets of improved workflow and increased quality of patient care.” Increased communication across clinicians exists as more and more of the record comes online. Automation can drive the creation and acceptance of the usage of codified data and standards. Defined best practices can be implemented electronically and monitored. Access to patient information is more secure and controlled.

Trends in the industry are toward demanding electronic records. More specialists create the need to share the record. So, start the process with gradual but noticeable changes, Reino recommended. “We’ve got to start somewhere.”