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September 1, 2007
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It's easy to lose sight of EHRs' basic advantages in today's national debate about electronic healthcare technology

The popularity of electronic health records (EHRs) has reached a pinnacle. EHRs are now a topic of national debate, presidential candidates' platforms, and editorials in major newspapers. The move toward the National Health Information Network (NHIN) is recognized by and supported in many state and federal agencies. Trade show agendas, once dedicated solely to clinical, advocacy, and leadership topics, are seeking to educate behavioral health and addiction treatment providers on the need for, and challenges and benefits of, the EHR. Yet the topic of technology to many in the helping professions is daunting enough without the added complexity of many of the latest topics, such as regional health information organizations (RHIOs), interoperability, and national data standards. Many providers probably are seriously wondering what the simple rewards for this major capital purchase are.

The successful implementation of an EHR allows a provider to operate on a new plateau. New-found efficiency includes reduction of documentation time, immediate access to patient data, improved cash flow, streamlined clinical work flow, increased reimbursement, and detailed real-time aggregate reporting. Believe it or not, despite all the techno-garble, EHRs truly enhance the quality of care provided and ultimately reduce the cost of care delivery. Let's review some basic returns of a move from paper to electronic.

A Harvard Medical publication stated, “Such a structure [paper] is inherently costly to administer—the share of US expenditures devoted to administration is variously estimated at one-fourth to one-fifth of the health dollar.”

1 Paper charts complicate data collection and require standard data to be collected at each point of the client's service. The preadmission and intake processes often have to be repeated, meaning clients are asked time-consuming questions again and again. Clients, often anxious and confused in this situation, are frustrated, and probably get the impression that the organization lacks proper internal communication.

Yet an EHR allows organizations to collect data only once. The impact of this on a once paper-based system is profound. A well-designed, EHR-based clinical work flow moves a patient through the preadmission, intake, treatment, and discharge processes without requiring data entry to be repeated. While we often are impressed by the glamour and glitz of an EHR's graphs and pictures, elimination of redundant data entry returns substantial time to a clinician's day (table).

Table. Paper records' staff productivity cost

Consider if a clinician spends the following time per client per day on paper charts:

Getting paper charts

2 minutes

Entering redundant data

2 minutes

Searching chart

1 minute


5 minutes

If the clinician sees 6 patients a day, he is spending 30 minutes a day on paper charts.

If a clinician works 260 days a year, this adds up to 7,800 minutes per year, or 130 hours per year spent on paper charts.

If a clinician's billable hour of service is worth $40, the agency is losing $5,200 per year because of one clinician's time spent on paper charts.

If the agency has 40 clinicians, it is losing $208,000 annually because of the clinicians' time spent on paper charts.

Not only do EHRs allow data to be collected only once, the data are available everywhere. With paper records, the client's ID and name have to be entered on each form, a tedious task eliminated by EHRs, which can place such information wherever and whenever desired.

Another basic benefit of EHRs is related to the storage and maintenance of charts. A client record is the only source of a patient's data an organization has to use as a tool in service delivery, yet in paper-based systems often the chart is not available when needed. In organizations with multiple sites, using paper-based charts as a real-time reference often is difficult or impossible. Staff members have to shuttle paper charts between buildings in an attempt to follow the point of service, but they often are far behind, meaning charts are not available to clinicians and doctors. Having only limited access to key data increases the risk of error as well as exposes organizations to potential privacy/security breaches. Tracking down charts becomes a part of day-to-day business and often is not recognized as a drain on productivity.

Maintaining paper-based records is a financial drain as well. Paper records are estimated to cost approximately $8.00 annually per record to maintain. Storage areas need to be maintained according to state, federal, and accreditation requirements. Storage policies typically require tracking, audit trails, and supervision, all of which are costly to organizations, add further human intervention, and increase expenditures in most instances. Many organizations have had to dedicate prime facility space to housing voluminous client records, in addition to incurring costly archival contracts with off-site storage facilities. In comparison, electronically storing data is extremely cheap and very compact. For example, a single computer CD can store in the region of 600 MB, equivalent to some 100,000 pages of text or about 200 large textbooks that would need more than 64 feet of shelf space.