Paper vs. Electronic Medical Records

Paper medical records

A paper medical record is any patient information, such as a patient chart, recorded on paper. They were widely used until about 10 or 20 years ago. 

However, paper-based records aren’t quite a thing of the past. The most recent published figures show that only 78 percent of office-based physicians and 96 percent of acute care hospitals use electronic records, suggesting that a small but persistent number of professionals continue to rely on paper records.

When should a practice use paper medical records?

While most modern practice management experts recommend switching to EMRs, some practices opt to use paper medical records if the initial cost of implementing EMRs is out of reach. You may also want to stick with paper if you have decades of experience with paper patient charts under your belt and don’t feel comfortable with digital technology. 

According to Dr. Austin Shuxiao, a board-certified internal medicine physician, paper records still have practical uses. “Power outages or scheduled EMR maintenance can be problematic. When the EMR goes offline, you can’t place orders, labs or chart notes digitally,” Dr. Shuxiao explained. “During residency, I once had a patient become unstable during scheduled maintenance. We had to physically request blood from the blood bank. Our response time was severely impacted.”

Dr. Shuxiao also noted that some experienced physicians find the transition to electronic systems challenging. “Older physicians often prefer paper charts because the learning curve for EMRs like Epic can be remarkably high. Even brilliant doctors can struggle with navigating complex digital systems.”

Tashin Azad, a business analyst at healthcare company Centene Corporation, pointed out that rural clinics or practices with smaller infrastructures may opt for paper because it’s easier to train staff and doesn’t require any internet access.

“Some veteran providers also use handwritten notes for quickness or convenience,” Azad added. 

Pros and cons of paper medical records

Here’s a look at the upsides and downsides of using paper medical records. 

Paper medical record pros

• Low initial costs: A rudimentary paper medical record system only requires paper, a printer, file folders and a filing cabinet. The combined cost of these items is typically less than the implementation fee and monthly rates for EMRs. (However, many practice management experts argue that EMRs result in lower long-term medical records retention costs.)
• Familiarity: Unless you’re brand-new to the medical industry, you’re probably familiar with how to create, complete and store paper medical records. That’s why some practitioners prefer using paper instead of switching to EMRs. Even a small learning curve can pose significant obstacles in a field as complex and urgent as medicine.
• No need for internet access: Paper records don’t rely on an internet connection, so staff can continue documenting and accessing patient information even when systems are down or unavailable.
• Handy in emergencies: During a power outage, IT failure or successful cyberattack, staff can quickly access physical records without having to log into a computer system. This can prevent delays in treatment for patients, particularly when their needs are urgent.
• Less exposure to cyberthreats: Paper records can be stolen, but storing them in a secure location makes theft harder. They can’t be hacked or accessed remotely and are immune to ransomware attacks, phishing and online data breaches.

Paper medical record cons

• Physical storage limits: The amount of space you have for paper medical records depends on the size of your filing cabinets. If you run out of room, you might find yourself storing your records offsite at a warehouse — an arrangement that could cause problems if you need to access records in an emergency.
• Likelihood of errors or confusion: Medical practitioners are notorious for their illegible handwriting. If practice staff can’t read a doctor’s paper charts, serious medical errors can occur. “I sometimes spend 10 to 15 minutes just trying to decipher handwriting,” Dr. Shuxiao explained. “Vital details, like medication dosage, should never rely on interpretation. Additionally, my own handwriting is poor, and errors aren’t easily corrected on paper, which might appear negligent if documentation is ever reviewed legally.”
• Incomplete data impacts clinical reporting: Azad cautioned that incomplete documentation in paper charts can result in care gaps being overlooked or noncompliance with HEDIS measures. He recalled an example: “A provider organization had great clinical outcomes, but because half of their data were not computerized, we could not confirm or give them credit for it. When good care does not translate to good data, paper is most often the culprit.”
• No easy way to track changes: By nature, medical records are continually updated and revised. It’s hard to note these amendments on paper without cluttering the records or losing clarity. While you could print new copies, your file folders can quickly become too large to manage efficiently.
• Limited information security: Physical locks — whether on building entryways or file cabinet doors — are often easier to breach than digital business security systems. Additionally, paper medical records rarely survive fires, natural disasters or other catastrophes, leaving practices at risk of losing everything with no backup available. [Read related article: Disaster Preparedness for Small Businesses]
• Not conducive to sharing: Sending paper-based patient records to other clinics or providers can be slow and cumbersome, leading to delays in patient care. There may also be security risks when faxing or mailing records. 
• Regulatory difficulties: Using paper records can make auditing and compliance checks more challenging, slower and less reliable. Your team may need to spend hours (or even longer) helping auditors locate, interpret and verify important documentation. 
• Scalability challenges: Paper records might suffice for day-to-day operations, but they don’t scale well as your practice expands or partners with larger organizations. “[The] very moment you need to scale, report or integrate with payers, paper starts to show its limitations,” Azad cautioned.

“Overall,” concluded Jeremy Shiner, founder and CEO of healthcare software company Myriad Systems, “paper is neither interoperable nor efficient from a business standpoint.”

Electronic medical records

EMRs are essentially digital equivalents of paper medical records. They help create a paperless office for medical practices by storing and granting authorized personnel and medical staff easy access to all patient charts and medical data.

To fully understand electronic medical records, it’s important to know the difference between EMRs and electronic health record (EHR) systems. EMRs and EHRs aren’t quite the same, even though the two abbreviations are often used interchangeably. An EHR system combines EMRs with tools like telehealth, e-prescribing and interoperability platforms to provide a better patient experience.

Most EHR systems also include practice management system (PMS) tools that create workflow automations to streamline front office tasks, such as scheduling, intake, registration, billing and patient communication. EHR systems with PMS tools can also typically support remote patient access.

Both EMRs and EHRs allow providers to create, update, securely store and quickly access patient charts.

When should a practice use electronic medical records?

If you want to enhance internal efficiency and improve patient care, consider converting your practice to an EMR system.

EMRs are also helpful for growing practices that want to add patients. A central, continually updated database can streamline data entry, retrieval, and management and simplify medical billing. [Read related article: Medical Billing Tips to Help Your Practice]

Dr. Shuxiao advises switching to an EMR system sooner rather than later. “Finding patient information from before the EMR switch is extremely difficult. If data isn’t imported digitally, it’s often lost to future use.” 

Shiner noted that rising patient expectations are accelerating the shift to digital systems. “The patient experience at large is driving technological improvement in health records, as patients now expect quickly accessible digital notes.”

Pros and cons of EMRs

Electronic medical records offer a much greater range of benefits than paper medical records, but there are still some downsides.

Electronic medical records pros

• Fewer storage limits: Your practice size and physical storage limitations won’t affect your EMR’s data management capabilities. Instead, your EMR plan will include a preset amount of cloud data storage that should easily accommodate all your digital patient charts. If you run out of digital storage space in your provider’s online document repository, you can contact your EMR vendor to discuss adding more.
• Easy-to-read records: EMRs allow you to enter patient records via keyboard or voice commands. Your records are easier to read, and others involved in your patient’s care won’t misunderstand your notes or make mistakes. Clearer documentation also makes medical coding and billing much more straightforward.
• Comprehensive, timestamped history of patient care: When you add entries to an EMR, the older versions of your charts don’t disappear. Instead, all previous versions are preserved with a timestamp, and all modifications are also timestamped. You and your team can view a patient’s complete care history. You’ll know what’s been done, what has and hasn’t worked, and what to do next.
• Data security: All reputable EMR platforms are Health Insurance Portability and Accountability Act (HIPAA)-compliant, meaning they boast stringent cybersecurity measures that minimize the chances of data breaches. Plus, electronic patient records won’t be destroyed if your practice or storage site is seriously damaged. It’s also no big deal if your EMR vendor experiences similar damage, as vendors back up their clients’ data at multiple locations. [Read related article: Security Tips to Protect Your Business’s Information]
• Interoperability measures: The best medical software platforms include interoperability tools that ensure the seamless, secure transfer of patient data to specialists involved in the patient’s care. These measures can facilitate the transfer of this data to new primary care physicians if your patient relocates or switches doctors. They also ensure compliance with various government programs.
• Telehealth and e-prescribing tools: Top EMR platforms include telehealth and e-prescribing tools that can be incredibly helpful for patients. Patients with mobility limitations or those requiring long-distance care can utilize telehealth for at-home appointments. Additionally, e-prescribing tools eliminate the tedium of printing paper prescriptions. They also flag potentially dangerous interactions between medications to keep your patients safe.
• More efficient internal operations: EMRs boost efficiency through tools that streamline documentation, admissions and patient safety. “Searching keywords like ‘heart failure’ instantly retrieves relevant past documentation,” explained Dr. Shuxiao, who also pointed to time-saving features like auto-populated templates and critical alerts. Azad added that EMRs “deliver timely, formatted data to track quality metrics, spot care gaps, and forecast patient outreach — none of this can be done on paper.”

Electronic medical records cons

• High upfront costs: EMRs often cost several hundred dollars per provider each month. Some also charge separate one-time setup fees that can reach thousands of dollars. However, over time, EMRs will likely save you money by reducing errors from illegible charts and eliminating the need for physical storage. Plus, the streamlined patient care they support can be invaluable.
• Learning curve: Not all EMRs are user-friendly and easy to learn, and even those that are can take time for your staff to master. Your practice may be less equipped than usual to tend to patient needs for a while. However, most leading EMR vendors provide hands-on setup assistance and guided training during the first few months of implementation.
• Reliance on internet access: If your medical practice doesn’t have access to high-speed business internet, EMRs may prove more frustrating than helpful. Without excellent bandwidth, you’ll likely struggle to load your EMR system quickly enough to access the information you need. However, given the medical industry’s gradual shift toward EMRs, investing in better internet and implementing an EMR system may be worth it.

Mark Fairlie contributed to this article.