Are EMRs And Paper Records Incompatible?

I just caught a blog post by the indefatigable Fred Trotter (a high-profile Open Source guy focused on HIT) which raised an important issue.  In his article, Trotter argues credibly that once a healthcare organization implements an EMR, its records are more or less incompatible with standard paper records.

Trotter cites the troubling case of two primary care groups which, despite the using same major EMR system, can only share data by printing out massive paper transcripts of a patient’s electronic record.

Apparently, each have a custom version of the system in place, which means that the two groups couldn’t share data directly. So when a patient from Practice A moves to Practice B, Practice A’s only option is to generate what — from a photo included in the article  — looks like thousands of pages of data.

Not only are such paper printouts awkward to store and manage, they’re painfully difficult to use. While traditional handwritten records provide a familiar, and relatively concise, source of medical data, this blizzard of paper could actually bury critical information.

After all, while the data might make sense when access via the EMR’s digital templates, doctors may not know where to find what they’re looking for when confronted with the print equivalent of a massive Excel spreadsheet.

Not only that, when Practice B scans this paper monster into its system, the problem just gets worse. When caring for the patient, B’s doctors will doubtless begin entering data into their own EMR system, piling structured data on top of incompatible scanned data. How clinicians will figure out what’s up with the patient is a mystery to me.

As commentors to Trotter’s item noted, the two practices could probably have shared a summary in Continuity of Care Document format. However, unless practices are willing to make do with a summary over the long term, they’re likely to confront paper printouts for quite some time.  Not a pretty picture, is it?

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.


  • At the risk of sounding politically incorrect, most of that old voluminous information will be next to useless to the next doctor. There’s no way anyone’s going to sit there and read 1500 pages of old medical records. They’re just going to start over and take her medical history over again from her own words. Maybe look at a few of the more recent records to get a handle.

  • I couldn’t help but comment on this, and I hope this doesn’t sound like a sales pitch, but eClinicalWorks had this figured out a while back. We launched P2P last year, which is essentially a tool to identify other providers on eClinicalWorks and effectively send them a CCD with all the information, embedded in the providers workflow of referrals. All the data get attached to the referral, and the providers in practice B can actually import all the information into their own instance of eCW. Seems like the solution to the problem you just presented, without explaining to a provider what CCD really is.

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