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Christine Tremblay

Health Care

How an EHR System Can Improve Quality in Healthcare Practices

Paper isn’t the problem, but it’s the vehicle for blame

Published: Monday, July 29, 2013 - 15:27

Most people are surprised to learn that more than half of small medical practices are still using handwritten paper charts to collect and store demographic and clinical information about patients. Although every medical office has computers, many doctors never touch them.

Other professions have adopted technology to help staff work more productively and achieve higher levels of quality in their work; the same can be true for the medical profession. Today’s practicing clinician is most concerned with understanding the effect paper charts have on quality in the medical office, obstacles to electronic chart adoption, and how implementing electronic health record (EHR) systems can improve the healthcare experience for clinicians, office staff, and patients. 

Paper’s role in quality care

Think about all the ways that illegible handwritten documents can negatively affect the quality of healthcare services. Between patient charts, insurance documents, and the paperwork involved with running a small business, a medical practice produces a steady influx of hard copies.

For example, the typical practice still receives hundreds of faxes daily. Quality issues created by misplacing faxes, attaching faxes to the wrong patient file, running out of paper, and unreadable printing are commonplace.

Quality issues typically start when the patient visit begins. A patient walks into a waiting room and immediately starts filling out paperwork. Patient-generated errors and illegible handwriting can easily carry over onto the patient chart.

In preparation for the upcoming appointments, office staff pulls patient charts from an enormous filing system that covers an entire wall of the office. Piles of charts sit on the front desk, waiting to topple over.

In the exam room, it’s cumbersome for nurses and physicians to flip through sheets of paper to review previous visits, vaccination records, and other data. What’s more, studies have shown that illegible handwriting accounts for an estimated 5 percent to 10 percent of medical errors, including misunderstood orders and prescriptions.

What is an EHR system, and why is adoption so slow?

All of these problems can be remedied by an EHR system. The software applications used in EHR systems allow physicians and staff to create patient charts, document patient visits, schedule appointments, electronically prescribe medications, coordinate care among multiple providers, generate bills for services, and much more.

EHR systems started gaining ground during the early 2000s, but widespread adoption has been slow. One barrier is poor usability. Many early EHR systems were designed by programmers who didn’t understand the workflow of a medical practice, and their systems disrupted workflow and frustrated physicians with an overreliance on clicks and checkboxes. Moreover, the physician’s ability to document “the narrative of the patient visit” was hindered, leading to inaccurate or misleading historical documentation.

The second major barrier has been affordability, as many EHR systems cost tens of thousands of dollars per physician to implement and operate. Practice owners have seen little return on investment from these expenses, which makes undecided colleagues reluctant to purchase.

Adoption of EHR systems has accelerated dramatically during the past three years due to government incentives. Physicians’ dissatisfaction with their first choice of an EHR system has led to switching to a different system once, twice, and even three times. Selecting the right EHR system, however, can help a medical practice improve quality in the delivery of care, office workflow, and the patient’s visit experience.

Improving the quality of care

EHR systems can play a critical role in improving care and patient outcomes in the short- and long-term. First, they help remove the guesswork and interpretation from physician handwriting in charts and administrative orders. Electronic prescribing helps improve quality by providing instant access to patient drug history, alternative formularies, and more. The EHR system can automatically flag dangerous drug-drug and drug-allergy combinations. This is not to say that errors do not occur. After all, humans still input the data, but digitizing the process dramatically decreases the margin of error.

In the exam room, clinical-decision support tools can provide physicians with relevant information based on the latest research. The EHR system can issue alerts for pre-disease warning signs based on health maintenance recommendations. For example, a 60-year old with hypertension may need testing for Type II Diabetes, or a teenager might be due for an immunization booster.

Most EHR systems today support the reporting of clinical quality measures (CQMs). CQMs are tools that help the government measure and track the quality of healthcare services. These measures use a wide variety of data that are associated with a provider’s ability to deliver high-quality care, or that relate to long-term goals for healthcare quality. CQMs range from tracking smoking status to exchanging key clinical data with other physicians.

An even larger goal of EHR systems is to aggregate patient data to determine and assess patterns, such as establishing health trends from a geographical standpoint or evaluating holistic patient health. In addition, measurement against predetermined goals and key performance indicators can help physicians assess the effectiveness of a particular treatment plan.

Improving the quality of office workflow

For office staff, an EHR system can improve the quality of service delivery. For instance, digitized information makes it easier to schedule visits, remind patients about follow-up appointments, and juggle multiple calendars with fewer mistakes.

Many EHR systems also feature intra-office messaging that improves the quality of communication throughout the practice by increasing the accuracy of information exchanges and leaving a permanent record.

When fully integrated with practice management systems on the backend, EHR systems can improve coding accuracy, accelerating the billing of insurance and patients while improving cash flow for the practice.

Integrating lab and radiology providers with the EHR system can also dramatically reduce the need for faxes. This allows lab results and radiology images to be automatically attached to patient charts and sent to physician inboxes. Even better, integration with a document management system can turn all faxes and other incoming documents into electronic files.

Improving the visit experience

Consider the EHR-enabled medical practice from the patient’s perspective. The front-desk staff now has information ready for review and approval before scheduled appointments, which offers patients a smoother check-in procedure that cuts down on paperwork upon entering the office. The pile of paper charts teetering on the front desk also disappears.

In advanced practices, the EHR system is tied to a secure website or patient portal that allows patients to update their medical history and insurance information before even arriving at the office. This also helps reduce errors due to illegible handwriting. 

In the exam room, the patient is more confident that the physician has the latest tools and technology at her disposal to deliver high-quality health care services.


As medical practices work toward improving the quality of the healthcare experience and outcomes for patients, incorporating an EHR system into a practice can be beneficial on multiple levels. With the right technology, physicians can start improving the experience as soon as a patient schedules an appointment.


About The Author

Christine Tremblay’s picture

Christine Tremblay

Christine Tremblay is the director of product strategy at Amazing Charts, developer of software systems for electronic health records.


Why is What ?

That's the crucial question that no EHR - or whatsoever ER - system will ever answer. For some reasons, I've had to do with some different health organizations in the last few months, all of them coordinated by the EU: some of them are computer-maniac, some others are computer-hostile. Why is it so? Where's the difference? Some of them only accept fax copies and don't know that some things like scanners and e-mail even exist, some others don't want fax copies. Certainly "paper isn't the problem, but it's the vehicle for blame"; and - as any vehicle - once fully EHRized, health organizations will be blamed for this vehicle, too. Thank you.