Paperless system solves problem of lost chart costs

Patient complaints now are handled in minutes

Three months may not seem like a very long time to evaluate a new paperless system, but "so far, so good" can accurately be applied to the T-System EV being used at the department of emergency medicine at University of North Carolina (UNC) Hospitals in Chapel Hill.

One of the major reasons for going paperless was that "we were losing approximately 4% of our paper charts," notes Jim Larson, MD, medical director of the department of emergency medicine, and since the system was implemented Nov. 9, 2004, not a single chart has been lost.

This is not insignificant, notes Larson. "You can’t bill for [lost charts], and it creates a medical/legal risk," he says. "We figured we’d see an instant improvement."

There’s also been a vast improvement in dealing with patient complaints, adds Jeff Strickler, RN, MA, clinical director of emergency services. "In the old system, you would invariably have to search for the paper record, which would take days to weeks to review, and then go on to the next step," he observes. "Now, I’m turning complaints around in minutes."

What’s more, Strickler says, cost-benefit projections indicate that savings in transcriptions alone could make the investment in software and licensing fees cost-neutral.

"The way our internal accounting system was set up, the ED would incur an expense for people from the medical records department to come to us when physicians would dictate a note, which would be done for all ED visits," he explains.

User-friendly for docs

The primary consideration in selecting this particular system, developed by T-System Inc. in Dallas, was how easily it could be understood and used by ED physicians, Larson explains. "It doesn’t matter if your system is easily networked [to the main hospital system], if it’s not easy for physicians to use," he notes. "This one is fairly intuitive."

"Our residents had already been familiar with [T-System’s] paper system in our community hospital setting," adds Abhi Mehrotra, MD, assistant medical director in the UNC department of emergency medicine. "The computer screen looks like the templates you see from the paper system."

To enter the medical record, the provider selects a chief complaint — for example, chest pain — and then with a series of checks and backslashes, creates a history for the patient. The system then will take these notations and put them into a prose format.

There are about 20 units in the department, most of which are desktop workstations, although there are several rolling carts with laptops as well, for use within patient rooms. "At some points, there are 50 people using the system at the same time," Mehrotra says.

Almost immediately after the charts are notated and locked, they are shipped electronically to the in-house hospital system, WebCis.

"They are then available for viewing immediately by residents, primary attendings, or any services consulting on the patient," he explains.

"The other really nice thing is before you would have to hunt down the nurses’ charts to look for vital signs, and so on. Now, the nurses are charting on the system itself, so if I’m concerned about the patient in room 12, I can just look for his vitals on the system," Mehrotra says.

Like Strickler, Mehrotra sees benefits to the new system in terms of transcription — and not just in hard dollars. "Before this, our attendings were dictating notes that were then transcribed and put in our homegrown system, and it was very time-consuming," he recalls.

Strickler notes that for every eight-hour shift, he typically would spend three to four hours after the shift or before the next one dictating. Now, after an eight-hour shift, Mehrotra spends perhaps an hour completing his charts. "That’s a big difference," he asserts. "If you’re tied up with charting, that takes productivity away from research and administration."

Management benefits seen

Speaking of administration, Strickler has seen a number of benefits to the paperless system from a managerial standpoint. "It’s tremendously more useful," he asserts. "From my desktop and office, I can get a very good picture of what’s going on in the department from [the chart] tracking."

The system also includes what Strickler calls "canned" administrative reports. "In the past, we had to do some data manipulation — download data from the main backbone system, load it into Excel, manipulate, and then finally we had something usable," he notes. "Now, we can get volume, LOS, timelines, and even carve it up by different sections in ED — or even a particular day of the week."

Much of that information is more accurate as well, Mehrotra adds. "Before when patients came in, we had LOS stamps for when they came through triage; now, when the greeter sees them, the timing starts right then, and you can see the entire stay," he notes. "It makes you realize exactly how long patients actually take to go through the department."


For more information in the T-System EV contact:

  • Abhi Mehrotra, MD, Assistant Medical Director, UNC Department of Emergency Medicine, Chapel Hill, NC. Phone: (919) 966-5933. E-mail:
  • Jeff Strickler, RN, MA, Clinical Director of Emergency Services, UNC Department of Emergency Medicine, Chapel Hill, NC. Phone: (919) 966-0068. E-mail:
  • T-System Inc., 4020 McEwen Drive, Suite 200, Dallas, TX 75244. Phone: (800) 667-2482. Web: