Continued Use of Pen and Paper with EMR may Provide Insight for Improved EMR Development

Physicians who have implemented an EMR but still use pen and paper to maintain certain records may help develop an even more useful EMR, new research from Indiana University-Purdue University Indianapolis (IUPUI) shows.

Jason Saleem, PhD, a Regenstrief Institute investigator, assistant research professor in the Purdue School of Engineering and Technology at IUPUI, and lead author of the study, began documenting healthcare professionals’ use of pen and paper after observing that doctors, nurse practitioners, nurses, pharmacists, and others who use EMRs still use index cards, notes taped or stuck to computers, and even notebooks. Saleem and his team of researchers uncovered 11 categories under which a healthcare professional’s reason for using paper could be classified, according to an article on the study that was published in the International Journal of Medical Informatics: “(1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security.”

According to the journal abstract, “paper served as an important tool and assisted healthcare employees in their work” in some circumstances, but the use of paper also “circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error” in other instances.

The team, who followed 20 healthcare professionals at the Roudebush VA Medical Center, concluded that examining the reasons for the continued use of pen and paper may enable develops to create a better EMR.

“Electronic medical records are instantly accessible to the healthcare team,” said Saleem. “But so much information is included in an electronic medical record, how does the individual health-care provider pick out what is important at a specific time? Not all uses of paper are bad and some may give us ideas on how to improve the interface between the health-care provider and the electronic record.”