Don't rush to paperless office. (Guest Editorial).

With the advent of the Health Insurance Portability and Accountability Act and the push toward electronic medical records, it seems clear that the great majority of U.S. physician practices eventually will transition to a completely paperless system of patient medical records.

Some medical offices are already there, but for most practices, paper remains a fixture. Indeed, a recent survey of medical groups conducted by my consulting firm, MediNetwork, indicates that only 23% of group practices have implemented some form of electronic medical records (EMR).

That's not necessarily a bad thing. It's better to use a functional paper-based system of patient record keeping and office management than to jump into an electronic system that does not provide enough efficiencies to justify its cost and the disruptive transition. Unfortunately, many physicians approach EMR in just this way. Often, it is the strictly paper-based practices that want to convert to electronic systems in a matter of weeks. Driven by HIPAA concerns or, more frequently, by peer pressure, these practices will attempt to run before they have learned to crawl.

Typically, these practices will implement a point-and-click system, with the physician using a laptop, PC, or handheld device to access a patient medical record form. Customized for each medical specialty, these pull-down systems drive the patient encounter, prompting the physician with a variety of options that can be clicked on based on the patient's response to questions. The pull-down menu also indicates appropriate billing for whatever services the physician provides or for any tests that are ordered.

These "experts" systems are designed to transfer the knowledge of the physician (the expert) into the machine. In accordance with HIPAA, these systems have been developed with sophisticated firewalls to make them secure.

The problem is that patient encounters are not so easily scripted. Patients and physicians are subject to nuances in behavior and vocabulary that frustrate categorization. ...