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?
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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