EMRs and Paper Records: Natural Enemies

How useful is an EMR when large volumes of data don’t get entered into the system?   It seems we’ll have plenty of chances to find out.

As the following story illustrates, clinical staffers will often revert to using paper documentation at their first opportunity, even if a perfectly nice EMR is available for use.

Apparently, U.S. Army mental health personnel working in Afganistan and Iraq aren’t entering patient data into the DoD’s AHLTA EMR system. The Army is now swamped with paper behavioral health records and has no system in place to scan and code the records for use within AHLTA, according to iHealth Beat.

Admittedly, entering data on the battlefield may pose some unique problems. Still, I doubt the DoD is the only organization facing this problem. After all, if you’re a clinician who’s been using paper records for decades, and somebody suddenly tells you to stand your work habits on their head, resistance is only natural.

Now, I’m well aware that even if the DoD hasn’t purchased one, there are systems available which can transform paper records into data usable by an EMR.

However, I’m fairly such systems are designed primarily to import data from  existing paper archives.  I doubt they could transform an ongoing stream of paper records into data quickly — much less in real time.

The truth is, paper and EMRs are natural enemies. You either chart it or you enter it, but the two are based on substantially different work flows.  If your health organization’s staff slips back into using  paper documentation, it’s not just an inconvenience, it’s a huge problem.

After all, just imagine the potential for patient harm if half the critical data lives on the EMR platform and half in paper.  When they need live patient data, what do clinicians do with a message from IT that says: “We’re two weeks behind on scanning — figure it out for yourself”?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I completely agree with your last statement. We scan all paper documents into our EMR system and then shred the paper. It’s the only way to be 100% certain that you don’t keep any paper patient documents in the office. Even our insurance billing documents for each patient, as the are mailed back from the company with payments, are uploaded to the system in real time, so nothing cab be misplaced or lost.

  • This is certainly a challenge but not an insurmounatable one. We have accepted the TV, Computer, and even the cell phone into our lives and we will also accept electronic medical records. It is a matter of habit and commitment. Commitment to the patient to provide better care. If we also make it easy to use, like Google, then there is an even greater chance it will be adopted.
    The biggest enemy of EMR’s is not paper, it is COMPLEX systems and software.
    So, my advice is to look for those systems that allow you to quickly and easily get up and running.

    Just out of interest, how many physicians still use a Franklin Planner? Not many I would guess!

  • Jim hits the nail on the head. One of the biggest hurdles to implementing an EHR system is being able to push through some preconceived fears that a complex system will cripple an agency.

    “clinical staffers will often revert to using paper documentation at their first opportunity, even if a perfectly nice EMR is available for use.” – Often a failure of training and consistency of use especially seen with the use of complex systems.

  • Hi All

    For the past year, I have been working with physician’s offices helping them with this same issue. An EHR system is essentially a software program running on a computer. If you go out today and buy a new computer the speed on that computer is pretty quick, but what happens in a year from now when you have put 2,000 songs and 3,000 pictures from your kid’s sporting events on there? That’s right, it slows down. Just like that computer, when you start scanning images to the EHR system it will slow down. How many pages are within a medical record? How many medical records do you have in your office? The main problem is whenever offices start scanning images to an EHR system the system slows down and fills up quickly with scanned images. We have a system that will keep the scanned images and the EHR system separate while linking the 2 systems together. Within the patient information of the EHR, we place an icon that can be clicked on that will pull the scanned images for that patient. For more information please email me at chunt@filemgmtpros.com or call my office at 800.869.6808.


  • Chris
    That is a great solution for a doc that has to store all their files and what you are doing is valuable.
    With the Mitochon System being cloud based there is nothing on a local computer which is great from a security perspective, and it also allows the computer to run at Optimum speed. This is not a simple decision and all these issues should be looked at when making the adoption of an EMR.

  • Great topic and some outstanding responses.

    Two thoughts come to mind when I consider the situation in the war zone. 1) That scenario probably was not considered when the analysis of how a new system should work was considered or a system would be in place to handle this situation, i.e., can documents be entered into a system in the field and if not what is the process to get the information into the system, 2) were the end-users involved in the system design. End-user input is essential for acceptance.

    Information is received in multiple formats everyday, i.e., paper documents, electronic documents, and data. The system should be designed to process this information regardless of the the format it is received.

  • Jim, I think your last comment was key. In addition to complicated systems, many EMRs simply address document management very poorly. Doctors receive multiple formats of information and most EMRs force the user to store in “restricted formats” like PDF or JPEG. The process of locating this information seems more cumbersome to the staff then locating the paper file and information.

    Aquarius has a Digital Charting System that was designed specifically to allow a practice to convert their paper charts into digital format. It can be customized to mirror their current structure and along with storing documents, it also stores static like X-Ray, CT Scans and MRIs as well as Doppler flow images. Our system can integrate with any EMR and is available in cloud or server based.


  • AHLTA is the WORST EMR I have ever used. We have complained bitterly about it ever since it was forced upon us in January 2004. It is a major reason doctors leave the services. I am so tired of administration telling us how wonderful it is, or promising that they heard the DoD is going to ditch it by 2014. I’ve heard that one before, but it was that it would be ditched by 2012…which hasn’t happened.
    The VA VistA EMR is so good; it is the BEST EMR I have ever used. But the DoD won’t use it.

  • We converted to a EMR system (eclinical) over a year ago. I can honestly say since day one we have been 100% documenting every encounter with patients. I love many aspects of the EMR; however, the One thing that has persisted is difficulty bring able to quickly view pertinent info for the patient. Our labs,mradiology reports, old office visits(pre-EMR) are scanned in and viewable; although, after jumping through 50 screens- and typically writing notes – it Seems to be a hinderence rather than a help. So… I decided to keep charts (although the info is scanned in) so I could easily flip through pages, while documenting and speaking with patient. This process seems to be the best of both worlds, and I plan to continue this until full lab and radiology integration is available.

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