The idea of moving to a paperless practice is daunting – or in any case to me. Our schedules are hectic, we are all trying to navigate in the time of Covid-19, we are overwhelmed with technological onslaughts (think endless Zoom consultations, emails, apps, finance software, practice solutions etc.), and yet, we knowwe need to take the plunge. Paper documents and filing cabinets have been the way to organize information in our practices (and at home) for decades. But that does not mean that physical, paper documentation is the best option – although for many of us, it is still the preferred way – and convenient. Also, as intimidating as the concept may be, going paperless with digital information management systems is a necessity to remain competitive in the modern world.
BUT WHY SHOULD WE TRANSITION? STUDIES SHOW THAT WE CAN LOSE AS MUCH AS 40% OF OUR TIME LOOKING FOR PAPER FILES AND DOCUMENTS – TRANSITIONING WILL MAKE US MORE EFFICIENT. FURTHERMORE, UP TO 50% OF ALL HARDCOPIES END UP IN THE TRASH – WE SHOULD BE MORE ENVIRONMENTALLY CONSCIOUS.
We also waste money on paper, printers, cartridges – going paperless is good for our bottom line. And finally, the transition to value-based healthcare requires us to measure outcomes and costs – for this a strong IT platform is needed.
The idea behind building a paperless office was first conceptualised in 1975 (“The office of the future”, Business Week) – and it was a lofty vision! Yet, in 2021, it is now within reach of all of us, while some have already transitioned – some more successfully than others. Most of us understand the need to transition, yet we are faced with some barriers – perhaps financial, perhaps time… but most likely, as in all change initiatives, our biggest barrier is our own uncertainty – born from a lack of knowledge.
But what is a paperless practice?
A paperless or paper-free practice is a work environment which uses minimal physical paper and instead uses primarily digital documents. The purpose of the set of articles which follow is to give you some insights and advice from our colleagues who are in the process of transitioning, or already have transitioned to a paperless practice. A series of questions were posed in interview format which were answered to help you to make better informed decisions. A big thank you to Drs Marcelle Stastny, Chris van den Berg, Pierre Malherbe, Jow’hara Chundra, Melane van Zyl, Shaun Janki and Eugene Allers for sharing their expertise and experience. Also included is an article by Dr Doris Viljoen, a futurist, on the trends influencing the future of psychiatry in South Africa (of which tele-medicine is a big one) and an article with legal advice for practicing psychiatry in the digital age by Elsabe Klinck, with commentary from Tibor Szabo (“Nibbles and Bytes”) – responsible for South African Psychiatry’s IT functions.
However, creating a paper-free office is an ongoing and incremental process, one which should be adapted and continually improved over time. It also requires a team effort – everyone in your practice – from receptionist, accountant, and even your patients, need to be on board. The most important step? Get started.
Enjoy the read!
DR MELANE VAN ZYL
Psychiatrist in private practice, Vanderbijlpark
What motivated you to transition into a paperless practice?
My main motivation to go paperless was to be able to access patient notes wherever I am. I am also interested to be able to collect data.
How long have you been practicing paperless?
It is a work in progress. I have been using Outcomes IT for nine months.
Which hardware do you use (e.g., laptop brand/ model, PC, speakers, earphones, screens, tablets, printer)?
Lenovo Thinkpad Yoga X1 (laptop), Ipad Pro, Ricoh
MP C307 (copy machine)
Which software do you use? Please motivate your choice (tell us more about the functionality)
Outcomes IT
What connectivity do you have (fibre, ADSL, etc)?
ADSL
What was your setup costs? And your monthly costs? (related to the paperless system)
Outcomes IT monthly subscription of R900 per Month
How do you manage power supply (i.e., what power backups do you have for Eskom…and how does load shedding affects you?)
I have an inverter, so power supply is sorted. However, in the one hospital I work there is usually no wifi or cell phone signal so I cannot take digital notes on Outcomes IT whilst I am there. I write all my notes with ordinary pen and paper and scan it in.
How do you manage scripts?
In my office I write scripts on Outcomes IT. When I am in the wards or do not have a printer available, I write on a script pad (always make a hard copy with carbon paper for the file) and scan it in into Outcomes.
How do you manage forms and reports? (e.g., PMB, chronic motivations)
Most reports I write in Word (on my letterhead), print a hard copy for the file and save a pdf to Outcomes. For PMBs and chronic forms I do hard copies (mostly- Discovery I do on HealthID) and save a hard copy in the patients file (with a note of the date it was sent in).
How do you manage lab results/ other results? Can your receptionist e.g., “export” it from your mail into the patient’s folder?
All my lab results are hard copies that are filed in the patient’s file.
What did you do with your paper folders? (did you scan it to the online folder? Did you keep your archive?)
I have all my files available (from starting my practice in this area in 2007).
How do you manage emails (do your patients use the practice address or your personal address? Does your receptionist screen? Can she file it in the necessary folder?)
I have a practice email (Outlook) which my two receptionists screen continuously. All emails that are not straightforward (e.g., about appointments or accounts) they print out for me and show it to me ASAP.
How do you manage other queries? E.g., a patient calls to check when the follow up is due, or a colleague calls to check re meds prescribed… could your receptionist then access the treatment plan and answer, or do you need to manage each and every query?
Straightforward queries are managed and noted in the dairy or accounts system. All clinical queries e.g., medication side-effects are written in the patient’s file and it is given to me. I also write notes regarding my answers in the file. I have protocols in place for requests for reports, emergencies, other doctors who want to speak to me, admissions etc.
How do you manage back-ups?
Outcomes It and my billing system is cloud based. I back up all the computers on a hard drive weekly.
How do you communicate with your receptionist re instructions re patients?
Communication with my staff is either verbal or on WhatsApp or email. All instructions and the outcomes are recorded in the patient’s file.
What would you consider the biggest pros of your transition to a paperless practice?
Pros include to be able to access notes wherever I am, and a good feeling that I am on track with falling in line with the ”digital future”. I really like the timer function on Outcomes IT.
What would you consider the biggest drawbacks or challenges your paperless practice?
AWBACKS INCLUDE THAT I OFTEN WORK WHERE I DO NOT HAVE INTERNET RECEPTION OR A PRINTER AVAILABLE, SO MUST RE-DO THIS WORK SO IT REFLECTS ON MY SYSTEM. THIS INCLUDES NOTE TAKING DURING THE MDT MEETINGS.
I also seem to do work for which there are no templates or separate filing “space” for in Outcomes, so I must scan this with the patient notes. (This includes EMDR, psychoanalytic psychotherapy sessions and DBT outpatient groups- when I start them)
Any specific comments re the customer experience for your patients?
My patients seem to be impressed with the printed scripts with the bar code. Consultations take longer, but nobody has complained yet. I have read reviews on the internet where patients seem to dislike it when the psychiatrist types during the interview.
Any other comments you would like to add?
I like the physicality of writing with a pen on paper. It might be the way I work now, but my consultations have space that patients can talk freely and “all over”, and I have learned through the years how to write notes that that are still structured and comprehensive in the end. It might be possible to do it this way digitally in the future, but I have found no app, device, or program yet that fits my note taking style. I like to handle the patients’ files. If I have it in my hand, I can judge how long the patient has been in my practice and how “complex” they might
be. Sort of a bird’s eye view/ instinctive feeling that I will not get by looking at a computer screen. Because my practice is extremely busy, I like to organise piles of files with specific tasks, e.g., scripts, reports, feedback reports, etc. I do the same with my billing- I make the flow of the accounts through the months visible by printing it out and moving it through 30, 60, 90 days etc. Almost like a Kanban system.
When I must write a long report or think of myself in court, I do prefer having a physical file. So, I think my patient notes are a bit like a security blanket!
Interviewed by Renata Schoeman
Published in the South African Psychiatry