Paperless: Ideal or Real?
Healthcare is not the only industry struggling to go "paperless." Although there is a fine distinction between phasing out what was once paper in favor of the electronic, and coming up with a completely new paradigm that makes paper obsolete, the goal is still a more fluid way of working without the very static use of paper. I believe the healthcare and design industries are grappling with these philosophical, yet very real, issues as contemporaries. In analogy syntax, building information modeling (BIM) is to paperless projects as electronic medical records are to paperless healthcare.
In design and construction,
paperless is most likely an ideal that will not be achieved in my lifetime. Although construction is adapting to BIM, which is a more multi-dimensional and representational design tool, paper drawings (or "construction documents" in industry parlance) are how the building transforms from an idea to an actual physical object.
Someday the BIM model may be a true collaboration masterpiece: trusted enough, imbued with enough information, accessible and understood by all team members (including field staff), and, most importantly, accepted by the legal community as an adequate,
if not more preferred, professional instrument of design. Someday it may be a perfect scale representation of what the finished product will be, maybe down to the last nut and bolt.
Much like the issues concerning BIM and a new design paradigm, the electronic medical records (EMR) discussion is nearly identical. Like BIM, healthcare providers seek a more modern tool to deliver care, an integrated tool that is a reliable improvement from the current paper trails that are so difficult to manage. Just as BIM will eventually provide building designs that ensure the public's safety, EMR has the care, safety, and privacy of every patient in every hospital and clinic nationwide relying on its success.
Unlike BIM, hospital EMRs must wrangle with legal issues like maintaining patient privacy and information security. The EMR will need to be an industry standard or common enough to be shared and easily accessed from virtually anywhere care is given. When a record is generated, providers must determine how to reliably add and save information and provide adequate redundancy. Much like the
Svalbard Global Seed Vault, which stores millions of seeds as the world's genetic back-up library for all plant life in the event of a cataclysm, EMRs will need a master file home base with similar redundancy in an environment that is hacker-proof. And then the debate on who owns the EMRs: the patient, the hospital, or system that is the patient’s home facility, or possibly the government?
Likewise, the construction industry will have to deal with similar issues with BIM. For healthcare, there may be more at stake given the scale of the EMR initiative and pressure for success. However, it is also federally funded, so there is more tangible incentive to jump in feet first in pursuit of "meaningful use.” It will be interesting to see how both industries evolve digitally, what that means for design, and what it means for the public's interaction with the healthcare and buildings of our future.
Lee writes on healthcare design, project, and strategy topics in his blog, “Owner’s Toolbox,” at