Why paper-based workflows remain relevant in an era of digital healthcare

Dr Jason Tee, Healthcare Industry Consultant for Lexmark, explains the benefits and uses of paper-based workflows in an increasingly digitalised healthcare sector.

The rapid and widespread digitalisation in the healthcare industry over the past few years – driven in no small part by the COVID-19 pandemic – has brought about massive benefits for medical providers and their patients.

By adopting new technology such as telemedicine, electronic medical records (EMR), online pharmacies, and in some instances, even artificial intelligence, healthcare providers have been able to streamline their operations and processes, while improving the quality of care they are able to provide to their patients.

The adoption of EMRs, in particular, has made it easier for healthcare providers to achieve the triple aim of healthcare – improving patient experience and safety, reducing the per capita cost of healthcare, and improving population health.

And according to Dr Jason Tee, the Healthcare Industry Consultant for Lexmark, one key advantage of EMRs is that it enables clinicians to access vital, up-to-date patient information immediately.

“EMRs, or other similar health information systems, have brought about a lot of benefits to healthcare operations,” said Dr Tee. “It improves operational efficiency by implementing clinical support tools, but what’s more important is that it allows for immediate access to patient information.”

“As a clinician, what we want is immediate access to updated medical information. This is very important, especially in patient care, because clinicians need to make informed decisions before prescribing and providing any treatment.”

The risks of hospital downtime

Given its convenience and multiple benefits, EMRs have largely become a staple for healthcare providers around the world, and is today heavily relied upon by many clinicians and staff.

An unplanned IT downtime events can be a serious threat to patient safety.

In a 2009 study published by the American Journal of Health-System Pharmacy, it was found that 39 medication errors occurred during a hospital downtime events in one year, 14 of which impacted the safety of a patient, and with one mistake resulting in an increased length of stay for the patient.

Meanwhile, a 2018 study published by the Journal of American Medical Informatics Association on the implications of EMR downtime showed that the majority of medication errors – such as the dispensing of incorrect medications and dosages – stemmed largely from administrative issues.

And hospital IT downtime, which often results in clinicians being unable to access and convey vital patient information in the EMR system, is a contributor to the gaps in the medication processes.

Explained Dr Tee: “IT downtime could hinder patient identification and information availability. A clinician then runs the risk of duplicating a prescription that could potentially pose an impact to patient safety.”

“In addition, clinicians may have to manually access patient records manually for several days on end during the event of a downtime. They may also be unfamiliar with their medical facility’s downtime contingency plans, which will lead to further slowdowns in an overloaded healthcare operation.

“This is where a downtime event can disrupt hospital operations, and will inevitably impose significant risk to the quality of patient care being provided.”

Why proper planning and a business continuity plan is key

As a result, it is critical for healthcare providers to implement an effective business continuity plan to allow hospital operations to carry on smoothly.

This typically involves the use of paper forms designed to help the hospital get through the downtime with as little fuss as possible. Such forms can include a downtime checklist, physician order list, clinical documentation progress notes, medical administration records, admission, transfer & discharge papers, as well as consent and registration forms.

However, as a result of their heavy reliance on EMRs, many clinicians are either unaware or unfamiliar with these forms, and as such, are unprepared for a downtime event.

“To effectively deliver care to patients, hospitals must have a contingency plan in place to handle EMR downtime, and this usually requires the use of the backup manual version of electronic forms. In some countries, like in the United States, this is a legal mandate,” Dr Tee elaborated.

“So, the key is how ready a clinician is in reacting to a downtime event, and being able to immediately revert to making full use of the paper forms available.

“That is why it is important for hospitals to have a successful business continuity and disaster recovery strategy that includes governance structure of executive commitments, identification of staff responsibility for the plan, a business impact analysis, a design for the plan, proper training, as well as maintenance.”

The importance of paper-based workflows in hospitals

Even as healthcare providers continue to press on with their digital journey, Dr Tee insists there remains a place for paper-based workflows in the industry.

Pointing to the long and close relationship that many clinicians have had with paper throughout their careers, Dr Tee said: “They continue to use paper notes because of the discomfort in using the computer while with a patient. They feel that if they spend too much time on the screen, it degrades both the patient’s and their own clinical practice experience by diverting contact and distracting from the patient-doctor relationship.”

Dr Tee added that there are also new uses for paper in a digitalised hospital – in particular, to fill the gaps in the facility’s EMR systems.

The continued use of paper-based workflows could also be down to regulatory factors, which sometimes dictate that paper copies of documents – such as informed consent, resuscitation status, or advanced health directives to clinicians – are produced.

Some institutional policies also dictate that verbal orders are to be written and on a paper chart, while certain prescriptions require both a physical and digital signature in order for it to be dispensed.

But arguably the most vital need for paper is during the healthcare providers’ downtime, as Dr Tee said: “Paper backups are essential to ensure the continuity of care and to avoid lapses in care during downtime, whether planned or unplanned.

“But EMR downtime preparation and recovery is a complex process. That is why at Lexmark, we have sought out to improve clinical efficiency with devices engineered to last, and tools to help minimise the issues healthcare providers face during downtime.”

Further highlighting the digital solutions to the critical issues that clinicians commonly face during downtime, Dr Tee said: “We know that during downtime, the lack of information access and control can impede clinician productivity and keep them from providing quality care.

“So Lexmark’s downtime assistant gives hospital 24/7 access to critical, up-to-date documents and reports – which are automatically fed to the device from a central source – when the IT system fails or when the network goes down.

“We also know that downtime situations can come in all kinds of shapes, size and situations. As such, our downtime assistant is designed to complement the capabilities of your EMR vendor to fill in any existing gaps so that you are fully prepared for any downtime situation.”

Dr Tee also emphasised the importance of having a digital solution that is user-friendly, so that clinicians can easily and effectively utilise it during critical downtime situations.

“Our downtime assistance simplifies the procedures so that clinicians can continue doing their job at ease,” said Dr Tee. “The solution makes critical forms and instructions available directly from the device, and users can access the most updated information with minimal training and less hassle.

Click here to learn more information about Lexmark’s Downtime Solution Offering. You can also contact Lexmark’s Healthcare Consultant at Jason.tee@lexmark.com to learn more about Lexmark’s clinical solutions and assessment of your facility’s printing requirements.”