Objective It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. We have evaluated the physicians' clinical work practices and attitudes towards a system in a hospital that has eliminated the paper-based counterpart using scanning technology.

Design Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians), compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system, without the scanning module.

Measurements The questionnaire covered frequency of use of the EMR system for 19 defined tasks, ease of performing them and user satisfaction. The interviews were open-ended.

Results The physicians routinely used the system for 9 out of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22-25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were however much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter.

Conclusion Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage towards fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.