for IBCLCs

Should you be a paperless IBCLC?

Paperless lactation consultant charting

I’m a paper loving girl.  If I buy a book, it’s hardcopy.  I can’t handle a to-do list app; it’s gotta be written on a slip of paper.  Meals for the week?  Jotted down and posted on the fridge, not added to the family Google calendar.

Since the moment I started my lactation private practice I’ve done all of my charting on paper, and I have to say, I really loved it.  I find it soothing to write things down.  Physically checking a box makes me happy.  Forms are orderly and clear and direct and they tell me what to do and I am nothing if not a rule follower.

But here’s the thing… my paper charts were quickly getting out of control.  I was stapling at least 6 pages together for every visit, never mind my follow-ups.  I was running through printer ink at an alarming rate.  It took me way too long to get my blank charts ready to bring to see clients, and if a client was emailing me it was a huge pain to put that info into their paper chart.

If I was in between home visits and a client contacted me with questions, I’d have to wait until I got home to answer because I didn’t have their chart in front of me.  It was incredibly frustrating.

And the monthly orders from Staples copy center were getting ridiculously expensive.

So… I’m in the process of switching to a paperless/cloud based EHR system.  I’m not going to lie, the transition hasn’t been easy- but I think once I get it all set up it’ll be worth it! 

If you’ve been charting on paper all along and you’re thinking about making the switch too, read on for basic info as well as some pros & cons.  I’m hoping that this information helps you to identify the best charting practices for your lactation business so you can continue focusing on helping families and babies.

What's EMR or EHR- and what's the difference?

An Electronic Medical record (EMR) or an Electronic Health record (EHR) are fairly similar.  Both are digital versions of paper charts, but an EHR goes past medical information and also includes other aspects of a patient’s health.  I’d say pretty confidently that in lactation land we are focused on overall health and NOT just medical and treatment history… so most of us really need EHR systems.

EMR systems are a bit old school as most providers are looking to integrate more of “the whole picture” into their treatments.  For this reason you’re going to hear more and more about EHR systems and less about EMR systems in the coming months and years.

Because EHR systems are more complicated and robust, they tend to be more difficult and expensive to set up.  They also usually allow (and really, require) the patient/client to access their own record and input data.  This might be an issue if you’re dealing with a population that doesn’t have cheap, reliable access to the internet.

Are there any EMR or EHR programs set up just for lactation consultants?

Yes, in fact in the USA there are almost two programs available!  Yes, I said almost.

  The first is Mobile Lactation Consultant, known as MLC, an EHR program focused just on (you guessed it) lactation.  It requires an iPad and doesn’t need to be connected to the internet while you chart. 

The second program, MilkNotes, has yet to be released but has been in beta testing for quite some time.  It can be used on any mobile device or laptop and the charts are cloud based, meaning you’ll need an internet connection to do your charting.

So wait, we’re limited to only these 1.5 EHR options?

Oh goodness no.  There are actually a slew of available EHR and EMR systems out there that can be customized for lactation.  You could set up an entire system through a HIPAA compliant Google account, there’s ChARM and Healthie and My Clients Plus and Practice Fusion and Simple Practice and… you’ve got a whole lot of options. 

But those aren’t exclusive to lactation. Won’t it be a lot of work to set them up so I can use them?

Yes.  Yes it will.  It’s taken me months so far and I’m not totally done yet.  I log in to the program almost every day to tweak things.

Now I’m overwhelmed. Do I really want to switch?

Well, it really depends how well your paper system is working for you.  Are you keeping ALL the information you need in the chart already?  Do you feel like you’re so married to your current system that you can’t possibly switch?  Then stay where you are!  If it ain’t broke don’t fix it.

On the other hand, do you feel like your charting system is a mess?  Are you doing the same steps over and over?  Are you sick of printing stuff out?  Do you always end up scrambling to find the right form at the right moment?   Are you worried that the handwritten directions you give to your clients aren’t properly detailed in their chart?  If any of these are true, it’s probably worth giving paperless charting a good look.

Ugh fine. But why can’t someone just explain it all and tell me what to do, step-by-step?

I have super duper great news for you.  Are you ready?

Someone CAN explain it all to you and tell you what to do step-by-step.  THERE’S A WHOLE BOOK!

I got the opportunity to test read/try out a couple of chapters from Annie Frisbie’s book Paperless Private Practice for the IBCLC, and when she finished the book I was able to get an advance copy to review. 

I got an e-copy… but then I had it printed and bound so I could scribble on it.  Yes, I printed out a book about going paperless.

The joke isn’t lost on me, folks.

What I love about this book is that it goes into great detail about why and how to set up a paperless lactation practice.   I’m talking step-by-step directions.  If you’re a rule follower like me you’ll love it.  You start at point A and end up at point Q and when you get there you’ve got all your basics done.

Now… can you 100% get up & running seamlessly from just what’s written in the book?  I’d say no.  There will always be personalization that you’ll need to do that a book just can’t lay out for you.  We all like to ask clients different questions, for example.  You’ll still need to go in and tweak things to your liking.

But this book does a really wonderful job of getting all the basics out of the way.  It also goes into depth about HIPAA laws, texting, email, faxes… all the stuff you could be (and probably are) doing wrong.  Lots of helpful advice, lots of take-it-or-leave-it information, and honestly there’s a ton of workflow tweaks and tips that can help you even if you stick with paper charting.  

If you use any sort of electronic communication with your clients, this book is worth buying.

How do I get this magical book?

Well, you can buy it here along with a set of lactation forms that can be imported into seven different EHR platforms.

You can even hire Annie for one-on-one consulting or to set up an EHR system for you.

But Annie has also generously offered to give away a FREE copy of her e-book to one of my blog readers.  And who doesn’t love free?  So we’re going to have a giveaway!

Giveaway is over- congrats to our winner Tiffany Carter Skillings, IBCLC!

So Rachel, what EHR system are you using?

Well, first I tried to use Mobile Lactation Consultant.  I spent two months and way too much time trying to get it set up to work for me, but in the end I ditched it.  Some IBCLCs love it; for me, it just wasn’t intuitive and it felt really clunky.

This December I decided to try ChARM EHR, and now I’m using it for most visits (just not the follow-ups for folks who have a paper chart).  There are pros and cons, just like with every EHR system.  ChARM is almost TOO customizable, and it can be hard to niche it down to exactly what I need it to do and no more.  It’s built for physicians so a lot of what it does just doesn’t apply to our job. 

On the plus side, charting and writing physician reports is WAY faster now.  That saves me time and means I can see more clients.  I like that I can access my charts on any device from anywhere as long as I have an Internet connection; no more having to wait to answer an email until I got home because I didn’t have the paper chart with me.

Getting ready to go to a visit is faster too, since I don’t have to put together enough blank chart packets on separate clipboards to make it through the day.

I didn’t really think about it, but I was paying $1.09 for printing every client packet.  ChARM is free for the first 50 “encounters” (visits) per month, so that saves me $55 a month.  Even when I start paying it’s .50/encounter- still half the price of my paper charts.  

ChARM offers a lot of add-on integrations for a monthly fee.  For example, I can add HIPAA compliant faxing straight from ChARM and it’s $25/month.  I can scan documents directly into ChARM for another $10 a month.  I could even add text & voice reminders for appointments for another $20/month… and then I’d be paying the same amount I pay now for paper charts!

So you’re all switched and 100% paperless and life is perfect?

Ha!  No.  I’m trying but this is a long process… much like getting a exclusively breastfed six month old baby to take a bottle.  I’m not charting on paper anymore but I’m still giving paper handouts and paper care plans and paper superbills.  ALL of these documents are created in ChARM.  I could absolutely do handouts, care plans and superbills electronically…  but I’m not comfortable with them yet so I’m still relying on paper.  It’ll get better. 

I can see the light at the end of the tunnel.

Hopefully I’ve answered at least some of your questions about switching to paperless private practice… and babbled on far too long as I usually do!  If you have questions I really strongly suggest you pick up Annie’s book.  You may also want to join one or both of these Facebook groups:

Paperless Private Practice for the IBCLC https://www.facebook.com/groups/paperlessppibclc/ (run by Annie and affiliated with her book)

Paperless IBCLC- https://www.facebook.com/groups/238456043009308/ (not affiliated with any brand)

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82 thoughts on “Should you be a paperless IBCLC?

  1. I am a new IBCLC and just starting to set up a PP. I was initally worried about cost of EHR but feel like the ability to submit electronic claims as a courtesy to clients is essential for my practice to grow in my community. So–I have been working on setting up CHARM this week. Most of it is intuitive and I look forward to having client communication better integrated in the system and accessibilty. I am far from being done with initial set up and would love guidance!

  2. I’d LOVE to be paperless, but my practice is so small I feel like I can’t afford to do it 🙁 Here we are 4 months into 2018 and I’ve had 4 clients. I’d love to learn more to see if I can make it work for me

  3. Hi Rachel, thanks for this post. I’m intrigued. My client forms are online (I love having them fill it out before I get there!) but on my end everything is still on paper. My biggest concerns about going paperless are the cost and time involved in setting it up.

  4. Newbie here in the prep phase of PP and just bought the book:). Love your article. I also am printing the book lol so I can scribble and tab.

  5. I am a new ibclc and have been paperless from the start. I love being able to fax pediatricians with a few taps on my iPad!

  6. I am already paperless, but I just use fillable pdfs and much of my paperwork is repetitious. I would like to switch to Charm or fully use G Suite, but I am reluctant to switch because of the set-up and learning the process. My son is a big techie and he will help me set things up, but I struggle to even decide what system I want to use.

  7. I am reluctant to go paperless because there is comfort in doing what I know and disruption while learning new things.

  8. I need a book to go paperless other wise i’ll never make it. Id evenk if this is where im supposed to comment. I’m so not gadget girl. You met me, you know what i mean.

  9. I am going paperless from the start and SO thankful for Annie’s invaluable insight to get begin my private practice paper-free!

  10. Hi Rachel! Thank you so much this post i really needed it. We started to make the move to paperless a year ago by building our own forms on g-suite. It was totally overwhelming and we ended up stopping. We really want/need to go paperless. We have some big projects on our plate for spring but our goal is to return to working on an EHR system this summer.

  11. Hi! I am already running a paperless office, but with my own forms ans templates. It was a lot of work getting everything set up, and it is still not perfect, so I would love to win Annie’s book to help me improve my system!

  12. I want to switch to paperless because it feels like all information organization systems are heading in that direction. Plus, I shudder at the thought of how much paper I go through, not to mention ink. My current system isn’t very environmentally friendly. I’m nervous about going to paperless mostly because I’m afraid that the associated costs will quickly add up. I suspect the savings on paper, ink, and TIME would make it worth it?

  13. I’m sitting the exam next year and really on the fence about how to handle records. I love hardcover books, etc, that feel like a record keeping via paper could easily get out of control very quickly.

  14. I love knowing so much information before I go into a consult. It gives me time to prepare and makes the visit more efficient. Both pages are liked!

  15. I’m paperless in some aspects of my business, but I really, really want to be fully paperless. Reluctant because I’m not sure of the best methods to choose. I don’t want to waste time and money trying out various ones that don’t work!

  16. Very interesting post. I am surrounded by paper! I have been thinking of switching to paperless for some time but it does seem complicated. Food for thought!

  17. I’m starting from scratch being newly certified . I know I want to be paperless, but it’s daunting to pick which system to go with. It’s a lot of work getting set up and I’m afraid of picking one and finding out I don’t prefer it after all that set up time.

  18. I would love to learn more about going paperless! I have a small practice, so implementing new systems is a lot of work for the amount of families I see. And, investing in anything new requires careful planning and thought. I’ve been interested in Paperless IBCLC for a while and would be thrilled to win this book and hopefully improve what I do.

  19. I’ve been using a program that has been free but will be going to a pay for fee system soon. I have enjoyed the flexibility paperless gives me as I’m not always in my office when I need to access files. I’m currently in the process of moving to a new EHR that was mentioned in your article. Thank you for putting it on my radar.

  20. My problem in choosing an EHR is due to lack of tech savvy and “paralysis of analysis”! I over think everything.

  21. I know I’ll need to be paperless when I start my practice but it feels overwhelming. I’d love to read this book!

  22. I use MLC and I’ve created my own consent forms, and imported other forms. I love that I can add places the client can add text, checks, or a signature. What I love most of all about being paperless is that I can access a chart anywhere. I also love that the info is stored locally (on my iPad) as well as on a server. In case one crashes, I don’t lose everything.

  23. I have been paperless for about 5 years now with systems I created myself, but there are always bugs. So I am looking at signing up for Jane since it seems it will be smoother for both me and my clients AND its Canadian, which is a bonus since the US products don’t always fit well with what I need here in Canada.

  24. Hi Rachel! Thanks for your blog. It was very informative. I’ve been struggling with paper for almost 3 years. And it’s a mess and I feel like it’s easy to lose pieces of my charts. I feel disorganized and that sometimes what I review with each client is slightly different. I want an EHR system to be consistent and organized . I’m leaning towards Charm but waiting on them to sign the BAA!! Thanks Cathleen Walker

  25. Thanks, Rachel, for great blogs. I am reluctant to go paperless because I have been using paper for almost 17 years and I am worried that I won’t be making as much eye contact with the clients if I am charting on a tablet, but I have so much stored paper!!!!

  26. I’ve been paperless for years, but I was very new when I started with an EHR. I’m starting to streamline my process and I’m sure there are things I’m not doing that I should be doing, and I’m sure there are things my EHR can make easier for me, and there may even be better EHRs out there, but the thought of switching after all these years seems to be too much..

  27. Can’t remember if I left a comment before! The more I learn about HIPAA compliance, the more I know I need to read thisbook!

  28. Already switched to MLC. Still getting used to it. I like that I’m not going through so much printer ink. My clients are young and like the iPad for inputting their own info. I need to figure out a few things but learning to love it and want to go more paperless now!

  29. Hi Rachel- I’m in my 3rd year in private practice and thought for sure I’d only want to stick with paper charting until I realized how much space it’s taking up and cost of printing forms. It’s slowly taking over my home office and leaving me feeling unorganized! I’d love a copy of this book to help me navigate the transition to paperless!

  30. I love using an EMR for a few reasons but especially having the ability to access all of my client files wherever I am. That convenience, while running a busy private practice, is so helpful.

  31. Great offer, thank you and thank you Annie.
    Taking the plunge to go paperless. I will need all the help and handholding I can get!

  32. I find paper so cumbersome, especially when trying to work with a partner. Paperless will be so much easier for us both to have access to information.

  33. Rachel thank you for making it easier for me to begin my private practice paperless! It’s a little overwhelming, okay maybe a lot overwhelming, but worth it. Annie has made it easier also as I toggle back and forth from her book to ChARM!

  34. Cost is my primary concern. I’m just beginning a practice and the people are “thrifty” in the rural area where I live. I’m afraid an expensive charting system will make overhead costs too high, so I’ll have to raise my prices beyond what most folks are comfortable paying.

  35. The up front investment (time and money) of going paperless without first being able to really see and understand how it will all work is a big deterrent for me — particularly as my private practice is still so very small and low-traffic that my overhead costs of using a paper system are really pretty minimal. But, the conveniences you describe are also very appealing.

  36. I got certified this January and am preparing everything for my private practice here in Glasgow, Scotland. I would love to go paperless straight away as it will be a lot of paper and ink to go through and I like to work as environmentally-friendly as possible, but I am really unsure where to start. I think the book would be a great start to understand the whole topic better.

  37. Thank you for this. Annie recommended I read it. Where are parts 1 & 2? I am going to become paperless, but still…..when I hold physical notes in my hand, I actually have something. So ingrained, right?

    1. Hi Ina! Thanks for pointing out to me that this blog post needs links to the previous ones 😉

  38. Love the article. Am thinking of going paperless for quite a while given that I have a paper mess (though found my way to keep it somehow organized enough). Worried when going paperless I will have an even bigger paperless mess, without the physical reminder of i.e. a pile of files for the clients I have to call, another pile for the clients I may not see again and file away, another pile for Aetna bills to write … . Have no idea how I would function without the beloved and so hated papers on my desk.

  39. Hi! Trying to win a book here and I love your page : ) I would say what led me to purchase MLC was because I am a RN and hospital IBCLC and computer charting is my thing. I’m having a hard time adjusting to ipad EHR charting, but I do love that it is secure and I don’t have to use a locking file cabinet and that I can use it online or offline. Those are almost the only things I love about it so far. HALLLLLLP!

  40. Hi Rachel –
    I’m reluctant to try paperless because of a few reasons. Firstly, I am brand new into private practice and launched just this month. I feel I need to get comfortable with the in-home consult aspect of care first before taking on a new documentation system. Secondly, I am a nurse in a hospital with mostly paper documentation, so it’s my comfort zone. I document well, and I know how to cover everything about a consult thoroughly and efficiently.
    I would love to win the book though and see where I could go with paperless.
    Lisa

  41. Working on a business plan to start my solo LC in PP this year! I just applied for a grant for a business startup and hoping to get going soon! As a nurse I have been involved in several build projects for EHR in the last 5-7 years and it is just so daunting! I just think this looks like a great resource and I am so happy that I can finally (hopefully) focus on my dream to open my own practice!

  42. I’m just starting my private practice, and using an EHR system just makes sense, but I am a little overwhelmed, and considering trying to find time to read Annie’s book to help me navigate setting it all up.

  43. Hi Rachel and Anne I have been very organized in my paper practice for a long time. It took a while but truly grab a file, run out the door, examine, chart, leave the superbill, care plan and send doctor report done before I leave. Yes all in duplicate using magic paper. Or as we seasoned humans remember as carbon paper. I am looking to rid myself of the clutter that all of this creates in my house, on my desk, in my car. I’m really motivated but scared to death. As I said I am a seasoned human and if I could get this done it may give those less familiar with technology a glimmer of hope.

  44. I made the switch after being in PP for 3 months. I was drowning in paper and found myself overwhelmed. I love love love EMR. I’ve been using MLC and there was a huge learning curve with it at first. But I do love it. It works for me and my practice!

  45. I am concerned that it will be a difficult and expensive process to switch to an EHR system. I think I will feel rushed to complete the process and become overwhelmed. I think that Annie’s information would be helpful to keep me on track.

  46. I started looking into paperless charting when I first became an IBCLC *years* ago, and have tested and discarded several of the free EHR options out there but am circling back to trying again by reassessing my needs and options. It’s so useful to think about the cost of paper charting – so often we think about the subscription costs for something, but not the accumulation of operational costs (e.g. printer ink, paper). Thanks for this!

  47. I am taking the exam in April, and making my business plan for private practice once I am certified. This post was so helpful! I am researching everything I can, so the book is on my list too!

  48. I really, really, REALLY want to be paperless in my PP. It seems very overwhelming to set up, and I’ve been so busy that I haven’t had the time or energy to fully research the options, much less actually get something set up. Maybe someday soon…

  49. I am currently using paper charting, then using a high speed scanner to scan the chart before shredding it. This is working well, inexpensive, and easy to use. I would switch to 100% paperless, but I am worried it won’t be worth the cost and time for a part time private practice. Still I keep reading about it and thinking it over.

  50. I am only six months into my private practice and the idea of paperless charting is very appealing! At this point, I am not overly invested in the habit of paper charting and I can see the value in paperless. My greatest concern is the time investment up front to switch.

  51. The practice I works for used MLC. I liked it only slightly better than completely paper charting.
    I believe that our devices and most of the programs we use are far more powerful than we utilize. In that spirit, I am configuring gSuite for my paperless practice.
    Everything I’ve learned through Annie’s book, and the community at large, about Google Drive, etc. and HIPPA compliance, etc is invaluable.

  52. Just starting a private practice and deciding which will work best. Leaning towards Paperless ? mostly for the record keeping and not having so much to store.

  53. I’m reluctant to start with an EHR because I am a compulsive researcher and want to make the Right Choice. Plus I am broke and need it to be virtually free. I was set to go paperless with G Suite, but then started wondering if I would be missing out if I didn’t try ChARM. Now I am wondering if I should combine the two. Would love to win a free copy of Annie’s book and have means for comparison!

  54. Hi, I’ve been unable to switch when the only option I thought that I had was MLC as I have no Apple products nor any sort of tablet. I’ve also been reluctant to switch because in addition to a monthly fee that I can not afford I would have to find the money to buy a tablet and have the money to pay a monthly fee for the service on the tablet. I don’t see enough clients in a year to pay for any of those things.

  55. Rachel & Annie, you ladies are fabulous. I faced many of the same issues and now have numerous lockable lateral files full of paperwork! I started building an access database that could hold all of our commonly repeated terms/care plans etc in 2014… My idea was to just sell the program to people but as time marched on I realized that it had to be “in the cloud” and more interactive. It’s killing me that it has taken so long to accomplish, but the team I’m working with now on MilkNotes has done a fabulous job. Yes, we are still in beta testing, but I just want it to be perfect… Thank you for your encouragement. It really will be “by LCs-for LCs”. Liz

  56. I would LOVE to go paperless. For the same reasons you outlined. I am spending way too much time and money on paper. It’s so, so daunting. Thanks for the write up! I look forward to checking out this book!

  57. Hi Rachel, I liked both pages :). I am hoping to go paperless at some point this year. I am not sure what route to go and am reluctant to spend a bunch of hours/money figuring out a good fit. Thanks for sharing your experience!

  58. Great article! I’ve been reluctant to switch to paperless since I have worked hard and spent money already to set up the charting system I have. I also don’t consider myself very tech-savvy, so it is rather daunting to go paperless!

  59. Thank you for this post! I am slowly transitioning to paperless. I only see a few clients a month so I do not want to invest a lot of money at this time but interested in having all of my information available wherever I am.

  60. Thank you Rachel for your always informative posts! I am a little hesitant about going paperless – I am afraid I will lose the personalization of paper charting

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