A Green Medical Practice

A Green Medical Practice

Every day I hear my staff say to someone, “Sorry, but we don’t work with faxes anymore. Do you have an email?”
Of course, everyone in business has an email, but you would be shocked to see how few actually use it to send or receive documents electronically. It’s that way in the medical field, anyway. When my office switched to electronic charts a few years ago, it was a cathartic experience and an unprecedented efficiency boost to my practice. It did not happen overnight. Resistance was stiff from my staff, who held onto the rituals of the patient charts, the sticking of labels and the little alphabet and year stickers. The rows of charts had their own square footage, and every year we culled them to make room for the new. Paper was stored in boxes, brought out and hole punched, labeled, written on and then stored again in files before going back into boxes.The search for an electronic medical records (EMR) vendor was tumultuous. The prices for these software systems range from $1,000 to $100,000. The more expensive systems will integrate your billing software and patient photos. Ease of use is not always guaranteed, however. All of the systems make their money by teasing you in and then keeping you with yearly dues that somehow always increase. The horror of the thought of changing all your charts to another EMR is enough to ensure fidelity for life. I’d bet that doctors change wives more often than EMR providers! Nevertheless, after some dating here and there, I got married to a system. So far it has been a joy. I have even tried to get some of my doctor friends to use the same system because I want to do them a favor, but it seems to be one of those things where everyone needs to discover their own path and make their own mistakes.At first I had a double system of charting. I would write in the electronic chart and also in the paper chart. That lasted a month. The paper lost. The efficiency of an electronic medical record meant that it was always available from multiple locations, and it was orderly and fail-safe in terms of  creating a timeline. An addendum was the only way to change something written on a paper chart—the data bits act like carvings in stone. Templates made my charting easier. A few clicks and the routine visit of a healing wound was charted while there was still room to add more info for the more complex cases.

We started the habit of getting things by mail or fax and then scanning them into the patient’s electronic chart. Bits of data were going from a computer that had generated the material to paper, to a fax, to paper and back into another computer. Paper everywhere—time wasted.

I received my first fax as a gift from my in-laws in 1990. It cost $800. It was the new technology, and it was great. My wife and I could “fax” notes back and forth to her parents, and it brought us all together and made Houston, Texas seem geographically closer.

A year ago, in 2010 and fully twenty years after my first fax,  I decided that I no longer wanted to bother with it. It has not been easy to drag others along. The hospital where I work has all its charts stored electronically, but they still want to fax over the operative reports for me to sign and fax back so they can scan them into the patient’s chart again. Vendors do not want to email receipts, etc.

On this point I am holding fast. It is ludicrous to continue with faxes. I can sign a paper if I need to and email it back.  The extra telephone line that was required for faxes is gone, and so are the reams of unwanted daily faxes advertising a quick getaway to Cancun. And all that beeping and whirring is finished too.

An electronic medical records system requires the accompaniment of electronic correspondence and puts an end to the use of paper shuffling. The fax is dead.

My fax machine works, but it has taken up a second career and is now performing much better as a garage ornament.

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon