Starting a fire with digital paper may be harder

I would like to share my comments from an online discussion (on LinkedIn – “​​Ditching Paper Saves Money, So What’s The Industry’s Holdup?”) which raised the issue of paper and more specifically going paperless. I have not edited these comments or reformatted them to look more like my regular blog, so the style is a little different from usual. Thanks for listening !

I always find it fascinating that people insist that the paperless office will never be. As proof, they say that they see more and more printing happening everyday. I run my office from home and it is effectively paperless. In the course of a year, I may print 10 pages. And the only reason I do so is because I have formerly been requested to do so by some service or conference, and because I have to sign something and then fax/email it back.

There is no question that the lack of a digital standard for secured and reliable signing of computerized documents, holds people back from dumping paper. My wife is a lawyer and her office is in our home, and she prints the final version of the contracts for her clients. I should point out that she only prints the final version. All of the earlier and modified versions stay purely digital. This alone is a tremendous savings in paper. And she is not alone. Many legal offices I know of, stick to digital until they need something signed.

My personal prediction is that paper will die by 2030. It will simply no longer be justifiable to kill all the trees and manufacture paper versus being purely digital. As it is, print versions of magazines are decreasing, and newspapers [in physical form] are dying.

At my previous place of employment, where I worked for 21 years, I and a colleague spent 11 years constantly updating the EMR that we developed from scratch. A few months ago, I quit that job. The EMR was 95% paperless. There were still doctors who submitted their charts in handwriting. I still have an entire model for a digital medical chart that would be very easy to use on a 10 inch tablet. And this model has stayed in my head for many years, waiting for the day when reasonable 10 inch tablets will be powerful enough, light enough and hold a charge long enough to be practical for doctors to use for an entire shift.

In my opinion, when a 10 inch tablet weighs no more than twice the weight of the clipboard, and can hold a charge for 36 hours or at least 24 hours, then it will be almost impossible to resist the elimination of paper and the introduction of a purely digital interface. If nothing else, you could scan all of the paper documents you have, and have software present them on the screen. The user would mark up the page, and the scan with the markup would be saved digitally as the formal documentation. The signature on the screen of such a tablet, associated with the scan, would be considered equivalent to an on paper signature.

A better version of this, would be for software to identify regions of the paper document where data is expected and to associate the entered information with a particular field. Now imagine the following: a physician walks into the patient’s room with such a tablet. The tablets automatically recognizes the RFID wristband that the patient has, and the ID that the physician has. The doctor literally hangs the tablet on the wall [on a special stand] and knows that the entire interaction with the patient will be voice recorded. With a single click the doctor can open a particular form and then through voice navigation, go through and fill in the necessary fields to document the case. During this interaction, the doctor can definitely spend almost all of his or her time looking at the patient and examining the patient, but orally passing information to the tablets. When the patient has a question, the doctor says “stop listening” like I do today with my voice to text software.

With all of this information now recorded, backend analytics can review the entire case, indicate what is missing from the history and physical to rule out certain critical diagnoses, offer a list of possible diagnoses to the physician and much more.

The time of paper is over. I wish that the major producers of tablets understood that creating a digital paper equivalent, would dramatically facilitate the conversion from paper to digital.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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