APIII - Advancing Practice, Instruction & Innovation Through Informatics

Eliminating Paper Laboratory Reports in a Complex Medical Center Environment

Walter H. Henricks, M.D. (henricw@ccf.org); Thomas Shirk, B.S.; Donald Bianchini, B.S.  Center for Pathology Informatics, Division of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH

Context:  In the era of electronic medical records, physicians routinely access laboratory results electronically, and there is less need for printed paper laboratory reports to be distributed.  Reasons for a laboratory to eliminate paper reports include fewer resources spent producing and distributing paper reports, reduction of waste and clutter, and clinicians’ desire not to receive paper reports.  In a complex medical environment, abrupt and complete cessation can be problematic as certain practice environments may have unique needs for paper reports.  We describe here our experience with a “grass roots” approach to laboratory report printing cessation based on direct communication with clinical services and physicians throughout the practice environment.

Technology:  Patient reports were generated from laboratory information systems (LISs) in anatomic and clinical pathology (Misys Healthcare Systems, Raleigh, NC; Cerner DHT Corp., Kansas City, MO).  Data analysis was performed in Excel spreadsheets (Microsoft, Redmond, WA).

Design:  Baseline data for clinical and anatomic pathology reports were collected, including number of reports, number of pages, printing consumable costs, and time spent distributing printed reports.  Every patient service location defined as a printing location in the LISs was contacted systematically to determine whether printed reports could be discontinued.  Delivery of printed reports was halted on a per-location basis after obtaining approval.  Units that wished to receive reports remained defined in the LISs as printing locations.  Printing volumes were tracked at approximately bi-weekly intervals to assess progress.

Results:  At 24 months, the monthly median number of printed reports was reduced from 83,259 to 370, a 99.6% reduction, and the number of printed pages fell from 133,690 to 616, or 99.5%.  Overall, 89% of physicians no longer receive paper laboratory reports.  The laboratory has realized an annualized savings of $44,728 in consumables and a reduction of 0.4 FTE time for sorting and distribution.  The main reasons that locations gave for retaining printed report delivery were: 1) lack of uniform adoption of the electronic medical record system; 2) use of printed reports as a double-check for diagnostic surgical pathology reports; 3) physician workflow preference.

Conclusion:  A proactive approach by the laboratory can effect the acceptance of laboratory report printing cessation in a complex environment.  Benefits include substantial reduction of paper clutter and some modest supply and labor cost savings.  Unique needs will dictate continuation of printed reports for some services.

Keywords – pathology informatics, laboratory information systems, electronic medical records