ArticleJournal of the American Medical Informatics Association : JAMIA
Comparing paper-based with electronic patient records: lessons learned during a study on diagnosis and procedure codes.
Article in Journal of the American Medical Informatics Association : JAMIA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 129 citations in OpenAlex.
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- The safety implications of missed test results for hospitalised patients: a systematic review.BMJ quality & safety · 2011Pooled it
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- Qualitative exploration of manual dental records in the digital era using sociotechnical systems theory: insight from a teaching dental institution.Journal of Yeungnam medical science · 2026Article
- A retrospective chart review of UK patients with advanced renal cell carcinoma treated with nivolumab plus ipilimumab.Future oncology (London, England) · 2025Article
- Enhancing clinical practice: the Endoscore app for automated surgical data capture and endometriosis scoring.Facts, views & vision in ObGyn · 2025Article
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- Ensuring equitable access to quality HIV care for affected populations in complex sociocultural settings: Lessons from Nigeria.PloS one · 2025Article
- Converting the existing disease surveillance from a paper-based to an electronic-based system using district health information system (DHIS-2) for real-time information: the Lebanese experience.BMC health services research · 2022Article
- Assessing the quality of electronic medical records in academic hospitals: A multi-center study in Iran.Frontiers in digital health · 2022Article
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- Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.Journal of medical Internet research · 2020Article
- Review
- Effects of real-time electronic data entry on HIV programme data quality in Lusaka, Zambia.Public health action · 2020Article
- Reliability of Paper-Based Routine Documentation in Psychiatric Inpatient Care and Recommendations for Further Improvement.Frontiers in psychiatry · 2019Article
- Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study.JMIR medical informatics · 2018Article
- A Novel Open-Source Novel App Improves Anesthesia Operating Room Equipment Supply.Journal of medical systems · 2018Article
- A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?Online journal of public health informatics · 2018Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Paper-based and electronic patient records generally are used in parallel to support different tasks. Many studies comparing their quality do not report sufficiently on the methods used. Few studies refer to the patient. Instead, most regard the paper record as the gold standard. Focusing on quality criteria, the current study compared the two records patient by patient, presuming that each might hold unique advantages. For surgical patients at a nonuniversity hospital, diagnosis and procedure codes from the hospital's electronic patient record (EPR set) were compared with the paper records (PPR set). Diagnosis coding from the paper-based patient record resulted in minor qualitative advantages. The EPR documentation showed potential advantages in both quality and quantity of procedure coding. As in many previous studies, the current study relied on a single individual to extract and transform contents from the paper record to compare PPR with EPR. The exploratory study, although limited, supports previous views of the complementary nature of paper and electronic records. The lessons learned from this study are that medical professionals should be cognizant of the possible discrepancies between paper and electronic information and look toward combining information from both records whenever appropriate. The inadequate methodology (transformations done by a single individual) used in the authors' study is typical of other studies in the field. The limited generalizability and restricted reproducibility of this commonly used approach emphasize the need to improve methods for comparing paper-based with electronic versions of a patient's chart.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.