5 steps to bring your Emergency Department from paper to Electronic Medical Records

There are many benefits of switching from paper-based documentation to electronic. Converting from charting your medical records on paper to an electronic format can seem like a daunting task, but several benefits make it worthwhile. Electronic Health Records (EHR) come in many varieties. Generic hospital-wide Health Information Systems (HIS) or department–specific systems such as Emergency Department Information Systems (EDIS). Often these can work together and suit both the broad needs of a hospital and the unique needs of an Emergency Department. 

EHRs are advancing our level of healthcare and leading to more productivity within a practice. Not only is the EHR changing the way practitioners document and store data, but it‘s also leading to better patient treatment and diagnosis. The New England Journal of Medicine reported that 82% of EHR users report improved clinical decision-making, 92% report improvement in communication with other providers and their patients, and 82% of users report a reduction in medication errors [i]. 

So, when is it the right time to switch? Since the early 2000s, Canadian EHR adoption rates have increased from about 20% of practitioners to an estimated 62% of practitioners across specialties, with substantial regional disparities ranging from roughly 40% of physicians in New Brunswick and Quebec to more than 75% of physicians in Alberta, in recent years, these numbers have increased [ii] .  

Where do you start? Think of EHRs as ‘enhanced‘ paper forms, with a switch in interface from the tactile, pen, and paper format you‘ve been accustomed to, to a point and click or touch interface that offers enhanced solutions. Below are a few steps to smooth your transition away from paper and to electronic. 

Step 1: Consider EHR Options 

What can you do to ensure you end up with the right EHR for your ED? There are many EHR systems in the market, many of them geared for a particular type of practice and others quite generic to be used by many differing specialties. Too many hospitals buy systems that aren‘t specifically designed for emergency departments. This is a recipe for dissatisfaction, as an ED‘s needs are unique and specially geared for an efficient workflow.

Step 2: Large HIS or Best-of-Breed?

Start by asking yourself, do you want a large Health Information System (HIS) or a best-of-breed system? Do you want to serve the ED’s specific needs, or are you more concerned about a system that serves a broad audience (or do you want both?). Are you in a large group or small group niche? Then look for the EHR solutions designed to serve your type of practice and your needs. This will help you reduce a list of dozens of vendors to just a handful. Often, if you work in a hospital, there may be an existing HIS that handles registration and basic needs leaving only a specific need for an ED-centric system. Remember, an EDIS and a HIS can work together. 

Step 3: Planning 

Timeline:  A clear timeline gives everyone involved a detailed plan and induces a sense of urgency. Without timelines, no one will treat the transition as a priority.  

Training:  Minimize implementation resistance by working together. All ED areas should be represented, from physicians and nurses to the front desk, billers, and medical records team. Ensure your physicians are involved; all physicians at your practise should participate in EHR training to save time and money. Involved physicians are more likely to adopt a new system willingly. Get them involved early! (even in the decision-making process).

Step 4: Transfer Paper Records (depending on need) 

There are a few challenges in dealing with health care files that can make it a slightly more tedious process to digitize. A few things to consider when switching:  

• Laws that determine how long a record must be kept 
• Do you have time to scan individual files?
• What to do with paper files after scanning?

Often, data repositories can be created for existing paper files to be scanned into. Both HIS and EDIS software allow for paper charts to be scanned into their files, which may be limited to recent visits or done at the time of the next visit.  The Canadian Medical Protective Association (CMPA) advises that for medical/legal purposes, you should retain your medical records for at least ten years (16 years in British Columbia) from the date of last entry or, in the case of minors, ten years (16 years in British Columbia) from when the patient reaches the age of majority [iii].    

Step 5: Adjust Workflow as Needed 

New processes often need refinement. Once you‘ve switched from paper to your EHR, take a step back and look at your workflow. Are templates in the EHR working to their max potential for providers? Is staff doing additional work that the EHR could do for them? Tweak and adapt workflows as you begin using your EHR. 

As you‘ve learned, switching EHRs doesn‘t have to be difficult, and the long-term benefits will outway the challenges. Check out Benefits of Electronic Documentation in the ED to read a Canadian physician’s perspective on switching from paper to electronic documentation. PulseCheck’s EDIS can help you make the change from paper records to electronic. We‘ve been doing it for nearly 25 years! Even if you are not in the market for a HIS or EDIS today, we‘d be happy to answer some questions and give you advice. Feel free to contact us at any time. 

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