The Limitations of the Paperless Office


The drive to have optometric office “go paperless” has been a clarion call since 2001, heralded in publications such as Optometric Management.  The high tech environment many of us live in certainly puts peer pressure on considering paper-driven records and non-computerized assessment and treatment as dated in some ways.  18 month old patients are coming into the office playing and learning on their parents’ iPads.  We seem to have skipped right over the Fisher-Price version, and accelerated directly into the real thing.  Yet there are still very important applications of paper that cannot yet be replaced with their electronic versions.

We’re all in transition from older ways of doing things in the office and at home to newer things.  In optometric vision therapy we continuously weigh the computerized versions of assessment and procedures designed to enhance, if not advance their low tech antecedents.  From the Visagraph/Readalyzer for eye movements to open-view autorefractors for accommodation, diagnostic insights are extended.  From the HTS family of programs to the in-office SVI and NVR programs, therapy becomes more interactive and feedback is enhanced.  Yet it is good to bear in mind that technology is not a substitute for an engaged doctor-therapist-patient relationship.

Plasticity Book CoverLast week I referenced a new work, Plasticity in Sensory Systems, which I received in the mail yesterday.  Not the ebook version, but the good ol’ hardback paper version.  I know that ultimately I’ll be doing the same kind of highlighting, underlining, dialoguing with the author, and generally immersive reading that I currently do with print version on electronic versions.  But at present my mind still engages more readily paper version.  Not exclusively, of course, or else you wouldn’t be reading this is an electronic format.  The chapter I was looking most forward to reading (though I was pleasantly surprised by some others) is the one by Susan R. Barry entitled Beyond the Critical Period: Acquiring Stereopsis in Adulthoood.  Among Sue’s many great insights, in this context I want to highlight the one with which she finishes her chapter:  “No two individuals adapt to their visual disorder in exactly the same way.  To harness adult neuroplasticity for visual or any other type of rehabilitation, one needs a highly motivated and engaged patient and a doctor or therapist with enough knowledge, experience, and flexibility to tailor therapy programs for each individual.  The best therapies are those that provide novelty and a sense of reward, and that train skills that are more easily translated to everyday life.  Once we focus our efforts on designing effective therapies, ones that match the individual’s needs, strengths, routines, and experiences, we may witness neurological recovery in ways that were once thought impossible.”

To be paperless or not isn’t the essential question.  Add this to the list of items for which we say it isn’t the tool that matters as much as what one does with the tool.  This applies to the doctor as much as it does to the therapist and the patient.  Le papier ne sera jamias mort!  Ne c’est pa?

2 thoughts on “The Limitations of the Paperless Office

  1. Hi Len,
    The paperless office issue for VT practices is of great interest to me. I personally prefer paper records because not many of us can attend to both another person AND a computer screen. Now, this may change a bit as we are able to use a stylus for recording performance notes and other data, but there is something about a computer screen that is so compelling that it is hard not to attend more to it than a person. I’m thinking of an old friend, and engineer, who routinely shuts off his monitor when his wife wants to speak with him. He simply cannot give both his full attention at the same time. His marriage, by the way, is excellent. I am convinced that there are few people who can actually do what we think of as multitasking, and perhaps a few more who can rapidly shift between tasks, But attending to a therapy patient, carefully observing the patient’s eyes, how they are dealing with the activity, their strategy, their performance, requires concentration and I find that not many people can work with a computer keyboard and program, and a patient. For that task, I think paper is superior for notation. Beside that, I’m not sure that a hard drive full of data that is seldom accessed after the patient has completed therapy is very useful–and of course, every hard drive will eventually fail, requiring massive backing up over many decades in practice. Finally, as you suggest, it is not so easy to highlight an electronic record, which brings to mind the old blonde joke about white out and the computer screen.

  2. Greetings Len,
    When I visit my PCP he doesn’t look at me and examines me at a glance, spending most of the time on the computer filling in the fields, and I still wonder if the prior field information is just copied and updated into the new established visit (less key strokes).
    Dr. Lane in his book “Visual Attention in Children” states that right handed people can’t multitask like left handed people, and on top of that the computer or the TV or video games change images faster than the brain can follow, so right handed people need to turn off the computer or TV when answering their wife’s questions. Great for Thomas Lecoq’s reply.
    Lastly, I want to spend time with my patients and observe so I will not go to EMR’s (and where would I place notes on FLK or notes on visual perception, visual memory, etc.) however the younger possibly left handed doctors will find it easier to switch. AND, how many times have I called another office for information and am told the system is down. Let the government deduct from my billing for not having EMR and when they push for EMR, I will retire, politics aside.
    Thanks for all you do. FLK is funny looking kid as the Ped’s call them.
    August Krymis

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