Most medical practices now use an electronic practice management (EPM) system. Usually this means some type of proprietary software, something different than the old system of hand-written calendar notes. In the last twenty years, the EPM market has ballooned into a large industry, generating products which run on several platforms.

Unfortunately, however, although these systems are enacted, the vision of the paperless office is not fulfilled. Most practices still store paper records in the old-fashioned way. Some practices are text-driven, such as family practices and internal medicine. Graphical and visually-driven specializations like ophthalmology, however, have given developers trouble and many systems are not ready to go live.

At our practice we had been using an EPM system since '83. The first vendor we were using said that they would not extend technical support after the year 2000. We decided to change to another system before this happened. While the software was good for billing and scheduling, we started to realize that we would need to keep growing in terms of square footage, in order to accommodate the storage of medical records. So, we asked ourselves which would be more cost-efficient in the end: conversion to an EMR system, or continual growing of the space? Our particular practice has five office spaces with records storage at the central main office. We started to consider a scanning solution to assist with the storage problem, still realizing that we'd have to become more efficient while maintaining full access to stored information.

EMR system implementation involves the following expenses:

* technical support

* IT consulting

* infrastructure costs

* computer hardware

* licensed software

Also consider the costs of training staff, and the extra data entry that they will perform to move information over to the new system. In most cases, a practice will use both the new and old systems until a conversion is complete. There could be some tasks duplicated between the two systems.

Our choice came down to a consideration of the necessity to curb the amount of paper records we were accumulating, meanwhile facing new privacy and patient record security proactively.

There are some excellent benefits to EMR, which include:

* enhanced documentation

* remote access

* improved coding and compliance

* better integration

* communication improvements

* measured efficiency

When making our choice, we imagined that we could recover our investment in five years; this calculation was based on savings on estimated office space rental needs. This includes reduced service costs and printing expenses. We are monitoring changes in job efficiency. There are benefits which are difficult to calculate accurately, but we are always measuring our performance and return on investment. There will be an initial investment of both time in expense which should reap benefits in terms of future productivity.

The overall trend seems to look toward a future in which EMR is the standard rule. Insurance providers and government agencies are increasing pressure for standardized medical documentation, and EMR could become obligatory someday. As healthy competition brings down hardware and software costs, even the smaller offices are then able to make the move over to a paperless practice.