Veterinary Economics October 2012 Mailbox

In Dr. Jeff Rothstein’s article, "Bite the bullet and go paperless" (June 2012), he says, "… at our one-year anniversary of being paperless, we no longer pull out the paper chart, except by special request—which almost never happens. The bottom line: Anything older than a year usually has little bearing on the pet's current health status.” He goes on to say, “And any chronic or ongoing conditions would be addressed and documented electronically during the transition year." I understand that there’s always room for disagreement and different approaches to care, but I find these statements to be utter nonsense.

It would be a rare week when I didn't find something of importance in a patient chart that has a major impact on the pet’s current condition, something that didn't come up the previous year. This week alone, I have found descriptions of drug and vaccine reactions, lick sores following clipping for venipuncture, evidence of incompatibility between client statements of heartworm preventive use and the amount provided, and so on. These items may not have triggered a "special request,” but they could have had an important impact on the patient's well-being.

I have a very good memory, but I see hundreds of animals. And clients are notorious for their failure to recall events or recognize their significance. We keep thorough patient records and organize them so that important items can be seen quickly, and before every appointment I try to review the entire history, so that I am properly prepared. How often have you personally gone to a doctor and been upset that he or she was unaware of important items in your medical past?

I don't believe there’s any good reason not to have a patient's full history readily available at each appointment, regardless of whether that record is on paper or digital media. Often the doctor doesn't know what information will be important until it’s checked.

Kenneth M. Kornheiser, DVM

Countryside Veterinary Clinic

Plainwell, Mich.

Author’s response:

Dr. Kornheiser,

You raise a good concern. However, I can tell you from personal experience that I have made the transition to paper in about 10 good-sized hospitals using the process described in “Bite the bullet and go paperless." It’s been very smooth and hasn’t been a problem for our veterinary team to adapt to. For established practices that want to go paperless, you have a few choices. First, you could input all old records from scratch, which is a tedious and costly process and one that would likely contain human error (due to the sheer volume of records, difficulty reading handwriting, and so on). Or you could pick a start date and enter all new transactions as paperless going forward and continue to refer to the paper charts until you no longer find you need them. (We typically find after a year we don't need them very often, but you can go as long as you like). You could also do a combination of these two or decide not to do it at all. It's easy to get caught up in analysis paralysis of what's the best way to go paperless. For our hospital group it came down to, "Let's do it," and we stuck with our original plan.

For us, many things like vaccine reactions are coded into the alert system in our veterinary software, so they show up automatically. Also, the medical history used for invoicing is still present and provides a general idea of tests, treatments, and medications prescribed.

In the end, we have to pick what we are comfortable with. I can only share what we've done over the past 15 years and what has worked well for a number of hospitals and nearly 200 team members.

Jeff Rothstein, DVM, MBA

President, Progressive Pet Animal Hospitals