Anyone go back to paper charts after EMR?

Specialties NP

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Interviewed for an interesting job last week. The practice (a specialty group) does NOT use an EMR and still has giant, thick paper charts. I currently work in primary care with a fully-integrated EMR. The more I think about going back to paper charting, the more I think "eek!". Not being able to read other providers' handwriting. Not having the system do drug-drug and drug-condition interactions. Not being able to send Rxs electronically. Not getting lab results electronically. Not being able to easily print out instructions for the patient. Lost/missing/disappeared charts. Etc., etc. The more I think, the less appealing it is. Has anyone gone back to paper charting after using an EMR and if you did, what was your experience like?

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I am still a relatively new NP but I went from all of my training on an EMR to on office with paper charting that just transitioned to an EMR in the past 8 months. Pros and cons to both are there. Paper charting can be quicker at times but handwriting can be a huge issue from my experience. We never had a big problem with lost or missing paper charts. A huge downfall of the paper charting is being without e-prescribing to check med interactions. With the paper charting I would often have to enter the meds into epocrates to check for interactions and as you know it is much easier with the EMR. I also print patient education materials a lot and had to rely more on pre-printed material There are days where I miss the paper charts and reviewing labs on paper is not bad as long as everyone kept up with the flow sheets that we had in the chart. Best of luck with the paper charting if you take the job and they may task you with helping set up an EMR since you have experience in the area (that is was happened to me anyway). I wouldn't let the paper charts deter you though from a job if it is something you are really interested in.

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Thanks for your insights! A friend of mine joked that when/if the practice gets an EMR, I will be a rock star. :yeah:

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Specializes in Emergency.

Just curious, do they have plans to go to an EMR? I haven't been keeping up with the details, but aren't they already giving up some reimbursement funds just by not doing eRx? I thought the EMR mandate was sometime this year (2014), no?

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Specializes in Nephrology, Cardiology, ER, ICU.

Yeah - I would question the financial acuity of this business manager of this practice. CMS has the dictates in place that EMR must be in place in order to receive reimbursement.

Electronic Health Records - Centers for Medicare & Medicaid Services

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Specializes in ICU, CCL, Tele, Some Management, TNCC.

Doesn't the mandate say something about 90% of charting has to be on an EMR by 2014..... Not sure but I think that includes all clinics too? Your office could be in for a very stressful 2014.

I went "backwards" with charting as a travel RN. I was traveling around my metroplex but found a PRN job at a hospital (incase I didn't want to deal with contracts etc. They were all paper charting. Had to grab my labs that were tubed to us and filed every morning :p charting 6 tele Pts by hand... Wasn't allowed to chart by exception (full notes q2h on each pt, my hand killed me!!!!!) it was a nightmare, that job didn't last long!

Your. Friend is right, you'll be a super user when that office finally goes EMR ;)

thanks! ~b. Sent from my iPhone using allnurses.com

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Specializes in FNP, ONP.

Providers that choose not to accept CMS plans do not have to convert to EMR, ever. I have a colleague that is opting out of medicare/caid, dropping all insurance plans, going to all cash pay and sticking with paper charts. In a lot of ways I envy her. Can you imagine how much angst she is going to save? No PAs, no billing, no BS. Just cash. $50 a visit, up front.

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This practice does not accept Medicare or Medicaid. So until their other payors insist, I guess they can get away without EMR. I inquired when/if they were planning to get an EMR and was told they hadn't found one yet that had what they wanted and was affordable. Practice Fusion is free, I pointed out. :) I write very detailed notes, and the thought of writing hand-written notes makes me cringe. They do dictate consult notes, but regular charting is handwritten. EEK!

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Specializes in Emergency.

BD, Yea, I have several friends who are looking at taking their practices that way as well. I'm afraid that may be an unexpected effect of the current fragmented/onerous payment system that exists in our current health care system. I will be very interested to see how it plays out and if they are able to make that practice work over time. Is the $50/visit actual, or an estimate?

AW, if you take the job, I would love to hear how your personal transition goes, if it is as bad as you expected, unexpected issues, etc.

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BD, Yea, I have several friends who are looking at taking their practices that way as well. I'm afraid that may be an unexpected effect of the current fragmented/onerous payment system that exists in our current health care system. I will be very interested to see how it plays out and if they are able to make that practice work over time. Is the $50/visit actual, or an estimate?

AW, if you take the job, I would love to hear how your personal transition goes, if it is as bad as you expected, unexpected issues, etc.

If I take the job, I will report my angst -- or no angst. :)

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Yes - it is painful to go backwards but you get used to it. My biggest frustration has been med lists (you better hope the most recept script got put in the chart, and that it's legible) and vaccine records (hopeless). I wouldn't accept or decline a job based on paper charting.

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Ugh, paper charts can be quite annoying! We have them in my current job. Finding the correct chart can be an issue, as well as handwriting. However, my previous job had the slowest computers in all the land. Even with a half way decent EMR, sometimes I would have killed for the convenience of opening a chat and handwriting a note. There are pros and cons to everything, I suppose.

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