Going Paperless: Can It Be Done?

Background. Since 1989, Beth Israel Hospital has been deploying an extensive online patient record (the OMR), which augmented a heavily used integrated hospital information system. Initially begun in a large primary care practice, the system is now used to share patient records among over 30 practices on three campuses. Although the system was intended to eliminate the need for paper, we found that it has, in the short term, increased the amount of paper produced. We wanted to explore the factors that contribute to this "paper paradox" and discuss the costs associated with increased paper production, areas in which we have reduced paper handling, and strategies for reducing our reliance on paper.