Most clinics struggle with these questions, and, given how the winds are blowing with compliance, reimbursement, and national healthcare policy, most conclude that going to electronic documentation is a question of ‘when’, and not ‘if’. Choosing the right time is usually a function of how dissatisfied you are with the status quo. Practices that have just been through an audit, have just lost a major referral source, realize that they are hemorrhaging cash from their revenue cycle, or are sick and tired of hauling charts home to finish on nights and weekends are most likely to transition quickly and with a sense of urgency.

Ironically, many of the practices that have transitioned find that their most acute problems were asymptomatic while on paper; when you don’t know, for example, how many charges were never posted, then that problem doesn’t contribute to your sense of urgency. If you are used to being embarrassed while covering a patient for a colleague, you don’t realize how much better the patient’s experience can be when you have access to your colleague’s comprehensive notes. If you’ve grown accustomed to hearing ‘where is patient Smith’s chart?’ many times each day, you don’t realize how liberating it is to have access to every chart with a few keystrokes.

Therapy directors who have used electronic documentation at previous practices, then find themselves in a new role at a practice with paper records, often think of the timing question in terms of opportunity cost – for every month they remain on paper, they suffer from lost revenue, audit anxiety, and illegible or missing charts.