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AMA delegates discuss best ways to go paperless

Experts speaking at the American Medical Association's annual House of Delegates meeting agreed that widespread adoption of electronic medical records is inevitable, but—during a symposium entitled Health Information Technology: Is It Help or Hype?—there was disagreement on the best way to wean a medical practice off its paper record system.

In her PowerPoint presentation, Barbara McAneny, an oncologist and chief executive officer of the New Mexico Cancer Center, Albuquerque, showed the 200 or so physicians in the audience a slide reading "Scan everything!!!" and then she recalled how her organization "hired every college kid in Albuquerque" to scan old paper charts into the new electronic system.

"It is expensive and it is necessary," she said. "And all this has to occur before you let the physicians get near the system."

A few weeks after everything is scanned and the EMR system is up and running, McAneny recommends shredding the paper records. "There is no going back," she warned, adding that the old file space at her organization is now being used as clinical space.

McAneny said that, as long as the paper-based system exists, there will be people on staff tempted to use it.

"The temptation is to run two systems and my advice is: Don't do it," she said. "You won't get the implementation you want."

But Philip Tally, a Bradenton, Fla., neurosurgeon who has been using health IT and developing software for 15 years, said that his organization took about three years to transition over to an entirely electronic system. He said it wasn't necessary to scan everything because, what they found they really needed were the most recent hospital discharge summaries and prescription records.

"We'd pull out practical things we needed to know and scanned those," he said.

McAneny, however, said that she still found 20-year-old pathology reports useful in her oncology practice and she was convinced that scanning everything was the way to proceed.

Another speaker, family physician Bernd Wollschlaeger showed a picture of his North Miami Beach, Fla., office which was devoid of filing cabinets.

"I have no paper records in my office," Wollschlaeger said, noting that scheduling for his cash-only practice is all done online.

He also said that, while he was waiting for his turn to speak, he used his personal computer to refill prescriptions and process appointment requests, and he explained that EMRs help physicians know what they're doing with their practice.

"This is not just a platitude," he said. "This gives me tremendous professional satisfaction—and it makes me money."

When speaking to IT vendors, Wollschlaeger recommended that physicians describe their typical patient and then ask the vendor how its product will help with that patient.

"If they say 'I'll get back to you,' they're gone," he said. "They need to be able to answer your basic questions."

All three speakers agreed that electronic records would become the norm, and Tally cited a study on consumer preferences for maintaining personal health records. According to Tally, 28% of those surveyed would prefer to store the records on a smart card, 27% prefer online storage, 21% wanted to use a flash drive, and 24% still preferred to keep records on paper.

"If you're one of those who still believe in paper," Tally said, "you better seek out that 24%."

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