Is Electronic Charting Less Efficient Than Paper Charting?

Summary and Comment |
May 30, 2014

Is Electronic Charting Less Efficient Than Paper Charting?

  1. Daniel J. Pallin, MD, MPH

Operational performance was similar before and after computerization at 23 community emergency departments.

  1. Daniel J. Pallin, MD, MPH

The federal government has provided $17 billion in incentives to computerize healthcare. The potential benefits include improved error checking, decision support, better billing, and more data for research. However, some research has suggested that going paperless adversely affects productivity.

To further examine this issue, investigators measured operational efficiency 6 months before and 6 months after implementation of an electronic health record system at 23 community emergency departments. No significant differences between the two time points were found in all efficiency factors that were measured, including time to provider, lengths of stay, walkouts, patient satisfaction, patients seen per provider per hour, and significant return visits.


Many emergency physicians would like to smash their computers, but these results suggest that, on average, we are no less efficient with computerized charting than with pen and paper.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee)


Reader Comments (12)

Dave Keller Physician, Family Medicine/General Practice, Hospital Urgent Care

I have to echo Dr. Engebricht's sentiments. The EPIC notes generated by use of templates are full of useless information and are not organized well. You have to search and search to find what you want. Even something like a simple wound check results in a lengthy note. My solution: make up your own templates using Dr. Weed's SOAP format, dictate the HPI using Dragon, highlight the real important information.

Scot Silverstein, MD Physician, Internal Medicine, Drexel University, Philadelphia, PA

The EHR issue is worse than written about in most medical journals. The systems, especially when poorly designed and/or implemented (common) interfere with already fragile clinical work processes and communications channels, leading to increased risk and actual patient harms. And lawsuits in which the physician is liable, even if the EHR system flaws and impediments were contributory or causative.

See my essay at and the 11 points there for a broader picture of the reality, and my academic site "Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties" at as well.

Dave Engbrecht Physician, Family Medicine/General Practice, Montana

Efficiency aside, and more important to patient care and quality, is the note useful to the next provider? Does it give the same nuance and physician to physician communication that a dictated note does? Very seldom. Whether an ER note or an office note, pounding square pegs in round holes for the benefit of the bureaucrat is unsound medicine.

Penny Steele RN Other Healthcare Professional, Surgery, General

I must say as an RN we also chart after shift..but we get in serious trouble for the overtime.EPIC disaster for anyone doing patient care. In the hospital setting M.D.s...please put your own orders in...I've got enough to do.

Roger Biss,MD Physician, Oncology

All emr's are not equal. Some make me faster and better. Some make it almost impossible to do good work. The lack of standardization , is the biggest problem . Hopefully sorts itself out before I retire.

Jay Hayner Physician, Internal Medicine, group practice

When we purchased our EMR the selling point was increased productivity. that has not happened. while our productivity has remained stable it is not because of efficient EMR but it is because, as the others have said, added after hours work. I remember when the chart was to keep track of the patient, it is now to keep track of the physician. So spending $17bil for the same productivity sounds about right. Classic federal program.

ARNOLD POTEK Physician, Family Medicine/General Practice, clinic

if paper vs elcectronic is a wash regarding efficiency and productivity, why is so much money and time being spent on hardware, learning curves and frustration when paper works just as well? in addition, low level jobs with health insurance are being lost to people who do not have education beyond high school and who performed paper tasks well. the electronic record is a farce perpetrated by corporations for increased profits at the expensive of an already overburdened health system. these profiteers have convinced us that the emperor has beautiful clothes when in fact he is naked

Michael Sherling MD Physician, Dermatology, Lake Worth, Florida
Competing Interests: co-founder of Modernizing Medicine, Electronic Records Company

Completely agree with the above two comments. Too often, decisions to implement certain records is made without understanding how it impacts physician workflow. The most important asset a physician has is their time. That means that EHRs need to be judged on how fast they are. Being just as good as paper isn't the goal we should be shooting for. At Modernizing Medicine, a new class of EHR products is out there that is touch based, specialty specific and does save time.

BRIAN GILLIGAN Other Healthcare Professional, Hospital Medicine

I bet it takes 6 months just to learn EHR system. I like to see operational efficiency 12 months after implementation .

John Brown, MD Physician, Family Medicine/General Practice, litttle office in big building

EHR puts an significant data input burden on physicians. The main advantage of the EHR (so far) is improving billing. Thus, EHR qualifies as a perverse economic incentive to administrators, while increasing the workload of physicians. Perhaps all physicians should be provided with a skilled person who could input the data.

THOMAS RICHARDSON Physician, Emergency Medicine, Hendricks. REgional Health

They didn't look at one key statistic--how long are docs staying to complete their charts after shifts are over. Sure, I can see what I did before because I have a good memory, and simply don't chart until I can, often at end of shift and thereby stay late. Most quality EM docs won't let a record slow their care up front--especially when quaility metrics are staring us down on time until seen or dischage. So we just chart later and go home later.

CLAY SMITH Physician, Emergency Medicine, Vanderbilt

The inefficiency cost is borne by physicians staying long after their shifts to complete cumbersome electronic health records, without reimbursement.

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