The Path to a Paperless Practice

The most compelling argument to switch to EHR is the one that starts and ends with the health of your practice

paperless office

The Path to a Paperless Practice

The most compelling argument to switch to EHR is the one that starts and ends with the health of your practice.

SCOT MORRIS, O.D., F.A.A.O. Conifer, Colo.

The "paperless practice" has long been the marketing "hot topic" in medicine, though until recently, it was virtually unachievable. In the very recent past, electronic health records (EHR) systems, or electronic medical records (EMR), faced a connectivity issue between prominent diagnostic technology and business operation software, such as accounting software. Other challenges: the conversion of the vast amount of business operational documents into electronic formats, and the reality that everyone else uses paper. As a result, less than 15% of the optometric profession has made the move to integrated EHR.

However, because evolving technology has addressed the challenges of connectivity and conversion, the right EHR system today won't only save your practice $70,000 through the next three years, but may also add $50,000 to your practice's profits annually. (I'll explain how I came to this figure later.)

Also, an EHR system vaults your practice to the leading edge of technology, saving you time and enhancing your image as the best eyecare practitioner.

Note: For this article, I define EHR as a completely integrated electronic information system that allows your practice to operate without paper.

The purpose of this article is to review how you currently use the information in "your paper" patient charts, how to effectively manage the transition into EHR, and I'll explain how EHR and document management systems will transform the information within these forms into a more productive, profitable and successful practice.

Why the hesitation?

Technology such as search engines, DVRs, MP3 players and cell phones are changing the world. They have shifted the paradigm of what we know about — and expect from — technology. In addition, grocery stores, airlines and hotels now offer self-checkout. Despite these developments, however, we still hesitate to adapt change into our own business world. Even when we get past the hesitation, many of us presume it costs too much to shift from paper to EHR. Interestingly, the evidence suggests otherwise. A review of the July 2007 issue of this journal ("EMR: The Real Costs," available at demonstrates that through a three-year period, the average paper-based optometric practice incurs almost $70,000 in additional expenses in the areas of scheduling, ordering, communications, storage, collection and coding. (To compare the efficiencies and cost-to-benefit ratios of the paperless practice, log on to flowprofits.)

Even more eye opening (pun not intended) is the physical cost of the chart. The July 2007 OM article estimated that the average chart in an optometric practice costs $3.71 to administer through its median three-year life span. Whether you have 10,000 or more charts in your practice, more than $37,000 of revenue is sitting in your filing cabinets with information that will take a tremendous amount of time to access. Every time you look down at a new patient chart, realize that $3.71 won't appear in your checking account.

The reality of technology

For optometric practices, the age of buying diagnostic boxes or software packages is behind us. We're in the age of buying access to information. In the last few years, a tremendous movement has occurred by all the technology players in the eyecare world to make a concerted effort to work together. Integration of diagnostic technology, EHR and utilization of document management advances has finally made the "paperless" practice a real possibility. With these changes comes access to information that we may have never known existed.

How to find valuable information in charts

STOP! Look at the chart on your desk. Do you know which pieces of information are truly valuable? Traditionally when we look at a patient chart — whether we can find it — we think about all the clinical information and maybe the coding data. Yet other information in the chart is valuable as well. Charts contain not only the obvious patient demographic, health history and clinical findings information, marketing information, such as your patient's buying patterns, preferences, hobbies and maybe even referral patterns (see "It's More Than Clinical Findings: The Information Contained in Your Paper Charts," below).

All charts contain valuable business and financial information, such as your top-selling frames, your profitability ratios by CPT or ICD-9 codes, your overall production by category (eyewear, professional services, contact lenses, etc.). The value of this information — information that you could never possibly access in a paper chart: Hundreds of dollars per chart each year when you access and utilize the information. Conversely, you're losing hundreds of dollars per chart if you're unwilling or unable to access this information.

How to turn data into profits

Access to this vital information provides significant marketing insights, increased profitability and a competitive advantage in an ever-tightening market. For example, in my practice, certain patients understand the value of premium eyewear. Year after year, they return to purchase $500-plus frames and $1,000 eyewear packages.

To learn about the demographics of these patients, we used our EHR records based on patients who've purchased $500 or more eyewear. We learned that these patients are typically female, myopic and between age 35 and 55.

What did we do with this valuable knowledge? My staff compiled a complete snail mail and e-mail address list for these patients, so we could personally invite them to our "Eyewear Expos," or trunk shows. With just one single query through EHR, our trunk shows have generated an annual profit of more than $50,000.

This is just one example of how the technologically integrated practice serves as a competitive advantage. How long does it take for you to access this kind of information, or do you? How much are you losing by not knowing whom to contact and send out mass mailings (or maybe you just don't send anything out because the task is so daunting)? Can you really afford to keep putting information on a medium that you can't access with a few clicks? Can you compete against your peers who have this ability. If so, for how long?

How to get paper into electronic information systems

The single largest fear practices have about converting to EHR is what to do with all that paper. Not just patient charts, but incoming faxes, mail, invoices, lab bills, patient referral letters, a health insurance company's explanation of benefits, bank statements, credit card statements, sticky notes, etc. When you consider how much paper you and your staff handle, search for, file, read, re-handle and re-file, you realize: "Paper is really expensive…and I have a lot of it."

In addition to advances in reporting functions in the top EHR programs, improvements in electronic document management have changed the way we assess information, regardless of medium. For roughly $200 a month, the new document management systems can take all your paper, read the embedded information through optical recognition tools, categorize it and place it on the necessary fields in your software so you can access and utilize it. The successful capture of one or two patients' records each month can pay for the monthly fees associated with your document management system. And, you'll likely capture dozens more records and, therefore, thousands of additional dollars by accessing and correctly utilizing the information within all the charts currently in your filing cabinets.

Companies exist that specialize in conversion of all of your medical records into usable information, ranging from portable document format (pdf files) to optical recognition software that converts any piece of information out of your handwritten charts. You can find many of these companies by conducting a simple search on the Internet. These companies are able to scan hundreds of pieces of paper per second at a fraction of the cost of what you spend to build your charts. Some companies can scan your documents for as little as $0.17 per chart — a big savings from $3.71 per physical chart. And, you can't access information from the physical chart unless you spend more time, energy and money to retrieve it.

How to rid your practice of old paper

Regardless of which medium you prefer, paper or electronic, the information is still there, just in different forms. The key difference is that in a digital medium, you can manipulate, access, store and search it faster and more efficiently than when on paper, enabling you to yield significant data. Again, this access is what often leads to the competitive advantage.

When it comes to the decades of paper charts piled around your practice, you can still access all the information imprisoned within those pages, either by manually sorting through the charts or by converting paper charts to electronic records. A variety of ways exist for you to convert your paper-based medical charts to electronic media. Popular conversion methods:

Solution #1. You may choose to send all your records to a professional service that spends the weekend scanning the charts and shredding them so that when you return to your practice on Monday, the information is in your computer system. Paper is eliminated from circulation after scanning, so this method is perfect for a practice in which the staff wants to revert back to paper.

Solution #2. Lease a document management system, and assign a staff member to operate it one chart at a time. The downsides: It costs staff time, and any information they place into a paper chart after scanning may create redundant information or may never get added to the electronic chart.

How to manage "new" paper

In the recent past, it was very difficult to say a practice was paperless, despite the use of an EHR system because everyone else (other practitioners, health insurance companies, etc.) was still using paper media. With the new document management capabilities of many leaders in the industry, however, you can now immediately transfer faxes into an electronic media that you can store as an image (.pdf, Joint Photographic Experts Group [.jpg], or bitmap [bmp]) or read optically. And, you can sort and send these faxes to various programs, such as an EHR system. This process virtually eliminates the error-prone redundant data entry, storage and access issues.

What to look for in the future (next year)

More than one EHR vendor is introducing a "premium practice" version of its software that will package not only all the benefits of their software and related third party interface tools, but also document management services and advanced practice management tools. Currently, many systems provide practice management tools, such as basic and intermediate reporting functions, cost-benefit analysis, inventory management and audit functionality, in addition to medical records. Soon, these companies will introduce software that can compare your practice's performance to established key performance indicators (KPI's). Vendors will integrate clinical protocol standards and utilize training tools to improve your clinical diagnostic and treatment skills and knowledge. Also, these same tools will enable the efficient management of business operations, such as the time clock, financial software integration, accounts payable tracking, health insurance benefit and claims processing in both directions.

But, you'll still have competitive challenges from your peers who've adapted to the Information Age. They'll have access to the information, allowing them to differentiate themselves, attain potentially explosive sales goals, improve their clinical practices and better manage the business side of their practices.

The survival of your optometric practice depends on your business savvy and how efficiently and effectively you manage your patients. Ultimately, these tools will create the foundation for evidence-based medicine in the next few years. OM

Dr. Scot Morris serves as the medical director of Eye Consultants of Colorado. He is the operating partner of Morris Education & Consulting Associates, a practice management and clinical education consulting firm. He is also the CEO of Ocular Technology Solutions, Inc., a technology consulting services company. Contact him at