Even with Electronic Medical Records, Paper Doesn't Decrease

When electronic medical records are introduced,
paper decreases, work gets organized, and the workplace becomes a little easier.
That is the image people tend to have.

In fact, there are parts that have become more convenient.
It is easier to search past records.
It is easier to track necessary information.
There are also parts that help with accounting and medical fee calculations.
I think it is certain that we can do more than in the era of only paper charts.

However, when you are on the front lines, something just doesn't sit right.
Even with electronic medical records, paper doesn't decrease.
And it doesn't feel like the work has decreased that much either.

Rather,hasn't electronic work just been added on top of paper work?
Sometimes I get that impression.

Paper remains more stubbornly than expected

If we switch to electronic medical records, paper will naturally disappear.
From the outside, that might be what people think.

But in reality, paper remains surprisingly stubborn.

For example, paper is needed for double-checking and signatures.
We print out paper for consent forms that require signatures and for explaining test results.
Label stickers to put on IV bottles.
Materials for committee activities such as safety or pressure ulcers.
Memos for rounds and handovers.
Sometimes we cannot input what happened on the spot,
so we write it on paper first and enter it into the electronic medical record later.

In other words, paper has not disappeared.
Electronic medical record work has been added while paper remains.

I don't think this is simply a matter of "not being used to it yet."
In the first place, on-site operations consist of
multiple flows such as confirmation, recording, sharing, printing, pasting, and circulation.
Even if you change only the recording medium from paper to a screen,
if the entire flow does not change, paper will remain.
Naturally, the work remains too.

Even if digitized, it won't get easier if it becomes a dual operation

What is happening on the front lines is
often not so much a "complete shift from paper to electronic" as it is
a dual operation of paper and electronic.

We take notes on paper on the spot and input them later.
Even if we record it in the electronic medical record, we print and distribute it for meetings and committees.
Even if instructions are issued electronically,
another piece of paper is needed for confirmation and signature checks.
When such things pile up,
rather than work being organized, layers are actually added.

It's not so much that electronic medical records are bad, but that even after introducing them,
I think the surrounding work design has not changed much.
The confirmation culture, meeting and committee culture, and document culture of the paper era remain as they are,
and electronic input is placed on top of that.
There is no way the front lines will become easier with that.

Work does not decrease due to digitization,only the format of the work increases.
Isn't that closer to the reality on the front lines?

Electronic medical records do not operate only within the screen

When people hear "electronic medical record," they tend to think of it as a "system for typing records on a PC."
But in reality, it is not completed only within the screen.

Terminals.
Networks.
Printers.
Label output devices.
Various settings.
Version upgrades.
Maintenance and troubleshooting.

Only when these surrounding environments are in place
do electronic medical records function in daily operations.

Conversely, if there is any flaw or deficiency somewhere in that system,
the burden immediately falls on the front lines.
And what makes it troublesome is that the ones bearing that burden
are often doctors, nurses, and administrative staff.
The same applies to other medical professionals.

In between their actual duties, they are forced to deal with equipment malfunctions, setting changes, and update requirements.
That is neither medical care, nursing, nor administration.
However, on the front lines, if someone doesn't take it on, things won't function.

The term 'digitization' gives a somewhat sophisticated impression.
But what is happening on the front lines is unexpectedly mundane and unglamorous.
Rather than reducing work, the introduction of electronic medical records
increases new types of hassle.

The benefits of 'efficiency' and the task of 'verification' are two different things.

Certainly, there are parts that become more efficient with electronic medical records.
In areas like accounting, point calculation, record searching, and information sharing,
there are many aspects where they are superior to paper charts.

However, whether that directly leads to a reduction in the burden on the front lines is another matter.

For example, electronic medical records help with calculating medical fees.
But the final verification is done by a person.
People also look at medical receipts.
People also check the consistency of input content.
People also check for any missing records.

In other words, while electronic medical records help with calculation and organization,
they do not automatically take over responsibility or verification.

This point is easily misunderstood.
It is often thought that digitization will reduce administrative burdens, but
in reality, it is not that simple.
Rather, if the amount of information increases due to digitization, the items that need to be verified also increase.
As a result, human checks do not disappear.

Therefore, it is hard to argue that introducing electronic medical records will reduce the need for personnel.
At least in the medical field, it is not that simple.

Is the problem with the 'machine' or the 'operation'?

What is important here is
that I do not want to make electronic medical records themselves the villain.
The problem is not so much the performance of individual devices or specific glitches, but rather
whether the entire operation after the introduction of electronic medical records is designed to reduce the burden on the front lines.

Which tasks should remain on paper?
Which tasks should be completed electronically?
Where and by whom is verification performed?
Is it really okay to assume that meetings and committee activities require printing?
Are there enough terminals for the front lines?
Who handles troubleshooting and updates?

If these things are not sufficiently considered, electronic medical records, even if they are convenient tools, will not become a system that makes life easier for the front lines.

Introducing electronic medical records and improving operations are not the same thing.
Between them lies a large gap called operational design.

To put it a bit bluntly,
just by installing electronic medical records,
thinking 'this must have made things more efficient' is quite dangerous.
Rather than DX, it might just be
layering digital on top of a paper culture.

What the front lines are looking for is not flashiness, but 'functioning properly'

What the medical field is looking for is not necessarily flashy, cutting-edge features.
It can be mundane.
Anyway, it just needs to function properly.
That is the biggest thing.

Being able to use a terminal when needed.
Being able to record when you want to record.
Being able to see necessary information without strain.
Being able to output what you need to output normally.
The verification flow not being too complicated.
Having a support system in place when you are in trouble.

Only when such basic things are in place
will electronic medical records become a 'helpful tool' for the front lines.

Conversely, if that is not organized,
electronic medical records will not be a magic wand to eliminate paper.
They will not become a tool to reduce staff either.
A system that is supposed to be convenient will end up creating a different form of burden.

Digitization is not about installing machines.

Even with electronic medical records, paperwork doesn't decrease.
I believe this fact is not merely confusion during a transition period,
but points to a more structural problem.

Paper is not the problem.
Electronic systems are not the problem either.
The problem lies in changing only the vessel for records without reviewing the entire workflow.

Digitization is not about replacing paper with screens.
I believe it means organizing everything, including how the site operates, the verification mechanisms, the supporting personnel, and the surrounding environment.

Only when that is achieved can electronic medical records truly become an ally to the workplace.
Conversely, if that is left behind, paper will remain, work will remain, and only the workplace will quietly grow exhausted.

Even with electronic medical records, paperwork doesn't decrease.
That sense of discomfort is not just in the minds of those on the front lines.
Rather, it may be revealing the true essence of digitization.