Guest posting by Bailey Flynn
This week, at our first design critique, we received an important question: what medium would we use for our solution—electronic or paper. Medicine, like most fields nowadays, is transitioning to become entirely paperless, so this is a crucial, but not simple, question. The hospital we are working with, Texas Children’s Hospital (TCH), is almost entirely paperless. All of their records, orders, and appointments are kept online, in a program made by Epic Systems. In 2006, TCH spent $60 million to begin switching to electronic medical records, and they’ve likely spent more since on upkeep for the system [1]. Indeed, the entire medical industry is making the switch, albeit somewhat slowly, to electronic medical records (EMR).
I do not wish to address here whether EMR are fundamentally a good or a bad thing. Either way, they are a reality. Instead, I’d like to focus on whether our solution specifically should be electronic or paper.
The logical answer to this question would seem to be electronic. Electronic records offer the potential to collaborate on a single document. They also allow for data logging and tracking over time. Since TCH is already paperless, our solution would better fit in with the environment if electronic. All hospital personnel use Epic, so integrating with an existing system could be a good thing.
However, developing an electronic solution may be difficult, especially given that we do not know how much ability we will have to modify Epic. Additionally, an electronic solution will likely have a slightly steeper learning curve than would a paper document. Finally, given that the electronic records are already so thorough, another electronic file may be viewed as a burden and could easily be forgotten.
I’m not ready to rule out paper as a viable medium. There are several disadvantages of paper, of course. Paper offers much less potential for collaboration. To view or edit it, one must be physically with it. It has the potential to get lost or ignored, as well. It’s also much less permanent than an electronic record.
However, paper is a tried-and-true method of communication. Paper offers several advantages—it’s user friendly, no one is uncomfortable using paper, it’s tangible and less easily forgotten (especially when it’s fluorescent pink). Currently, the checklist that is used for liver transplant patients is paper. I’d imagine it’s one of the few paper records left within the hospital. On the one hand, paper would stand out in a paperless hospital—but is that such a bad thing?
In the end, I think the critical point to consider is: what would doctors and nurses use more? Our solution, no matter how elegant, is entirely pointless if it isn’t used. In the coming weeks, I hope to dialogue with nurses and doctors about their preferences.
[1] http://www.bizjournals.com/houston/stories/2006/08/21/story2.html?page=all
Here are some related articles that I found interesting:
Forbes: Less Than Two Percent of Hospitals Are Paperless as Medicare Penalties Loom