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The Paperless Medical Office?

Going paperless is a hot issue in medical practice management today. It sounds like a great idea with lots of benefits and no downsides. But is this true? There are significant benefits and savings in going paperless (as far as is currently possible) but there are critical issues that need to addressed which may completely reverse any expected cost savings.

What can be paperless?
Currently, it is not possible to be completely paperless in medical practice. Most areas of practice can be relatively paper-free but still involve paper as the medium of communication between the practice and other practitioners, hospitals, labs or funding bodies. Probably paper-light is a better term and covers the following areas:
  • billing & receipting including Medicare Online
  • letter management
  • clinical notes
  • appointment & procedure booking
  • prescribing
  • test ordering
  • incoming documentation from referrers and other sources

The Benefits
Typically, when a doctor says they are going paperless, they mean that all incoming documents are going to be scanned into their practice management system. No more filing cabinets!
To my mind, the benefits are the following:
  • the ability to access your documents from anywhere. This can be accomplished in a number of ways such as via the web or by synchronising the files to your laptop. This is THE reason for going paperless I think. It offers the potential for having your clinical information with you at the moment you need to make a decision.
  • data security. Destruction of your rooms with your filing cabinets is a disaster. Appropriate off-site backup of your paperless office means you haven’t lost anything.
  • submitting accounts electronically can offer quicker turnarounds and savings. Medicare Online bulk bills are usually paid within 36 hours. Postage is unnecessary for these accounts.
  • communicating with colleagues and patients using email and SMS. Note that patient information is confidential and must not be sent unencrypted.
  • clinical documents are now legible.
  • no more filing cabinets. Filing cabinets take up space that costs money and filing files takes up staff time.

Numerically, there aren’t a lot of benefits in going paperless and it is difficult to put a dollar value on the one I think is the most important ie having your data wherever you go. The cost of the filing cabinets is obviously going to vary with your actual floor costs.

The Costs
Whilst the benefits of going paperless can be somewhat intangible, the costs are definitely not and are commonly grossly underestimated by doctors contemplating this option. Going paperless is a major endeavour.
The costs are:
  • equipment-related costs
    • modern computers have enough horsepower to manage electronic documents but you may need to upgrade your hard disk storage as scanned documents and photos can eat up storage space.
      • expect to replace computers every three years maximum
    • document scanner. You should budget around $1500 for one of these. Do not think that your current flatbed scanner will suffice - it won’t.
    • backup devices and software
      • you need to budget for devices to support at least two rotating backups as well as software that allows you to schedule automatic backups
      • offsite storage of a backup is essential in the paperless environment
    • high-speed internet connection is essential for the remote backup service
  • staff-related costs
    • you have to learn to type
    • get good staff that are IT-aware.
    • training. Filing cabinets have a user manual that is less than one page long and require minimal training for new users. A paperless environment requires staff that are tech-savvy which basically means that they have been adequately trained in the whole of the office’s IT. This means, for example, that all staff members can recover the system from a fatal crash. If your system goes down for any reason, your practice stops.
  • security costs
    • regulatory bodies place higher demands on the electronic storage of documents than they do on paper storage. We have mentioned the issue of adequate backups above
    • physical security. Not only does the access to your rooms need to be secure, the access to your computer needs to be secure as well. If you are running a single user system, the computer should be secured by a physical security system. Servers should be locked in a cupboard with adequate ventilation.
  • support costs
    • the better trained your staff are, the lower your support costs. A paperless system is much more complex than a conventional system and is less fault-tolerant. You are going to need IT support from a reputable person or firm. Make sure you contact us for recommended people.
    • typically, IT support runs around $120 - $150 per hour. Consider a support contract for both the software and hardware.
  • practice management limitations
    • Medicare Online offers the tantalising benefit of quick turnaround of payments. However, this is only true if you accept the rebate fee or have a strict policy of getting paid in full at the time of consultation.
    • the glue that will tie your practice into the wider health care network is not in place yet. There is no way for transmitting your path requests and prescriptions electronically to labs or pharmacies. The main benefit is that they are now legible.

A paperless practice can be a great idea. However, the cost-benefit equation needs to be done for each practice because the costs can very rapidly get out of control.