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The digital dilemma: why are hospital op notes still on paper?

Using a typewriter to create a paper op note

As someone who has been a surgeon for over three decades, it’s fascinating to look back and reflect on the evolution of medical practices. However, one aspect of healthcare that seems to be stuck in time is the method of documenting patient records, specifically, operation notes. In this blog post, we’ll delve into the persistent use of paper operation notes in many Australian hospitals and explore the challenges that have hindered the adoption of electronic clinical note systems.

Blast from the past

Rewind to the early 1980s, and doctors like myself were handed thick paper files with cardboard edges for documenting patient records. These files contained everything from clinical notes and administrative details to drug charts and test results. The process involved physically sifting through these files to access patient information. This antiquated system may sound like ancient history, but surprisingly, it still prevails in many private hospitals across Australia, and even some public hospitals.

Digital divide

In an era where technology has revolutionised nearly every aspect of our lives, it’s perplexing that the majority of hospitals in Australia continue to rely on paper operation notes. While other hospital functions like scheduling, finances, and rostering have transitioned to electronic systems, clinical notes have been largely left behind.

Cost barrier

One significant obstacle hindering the transition to electronic clinical notes is the prohibitive cost. Many hospitals, especially private ones, are hesitant to invest in these systems due to budget constraints. Additionally, the fragmented nature of medical practice in Australia poses a unique challenge.

Contractor conundrum

In the Australian healthcare system, most doctors are independent contractors who work across multiple hospitals. They aren’t employees of these hospitals and, therefore, don’t have access to the hospital’s administrative networks unless specifically set up for it. Training doctors to use electronic systems can be tedious and time-consuming, given that they may work at several hospitals concurrently, each with its own system. Since doctors are usually compensated through patient billings rather than by the hospital, they lack a financial incentive to invest their time in training on these systems.

Roadblocks to compliance

One of the critical issues that electronic clinical note systems could address is the compliance with Australian standards and health fund suggestions. Shockingly, the majority of operation notes in Australia fall short of these standards, jeopardising patient safety and care. These discrepancies highlight the urgent need for a modernised, electronic approach to clinical notes.


Despite the immense advancements in medical technology, the persistence of paper operation notes in Australian hospitals raises serious questions about the efficiency and safety of healthcare delivery. Overcoming the challenges of cost, fragmented practice models, and compliance issues is essential for the successful adoption of electronic clinical note systems. It’s high time we bridge the digital divide in healthcare and embrace the potential for enhanced patient care and safety that modern technology offers.

At Praccelerate, we have built an application to help solve the problem? Create an account and start writing digital op notes today.

Dr. Howard Webster

Dr Howard Webster is one of Australia’s most experienced plastic surgeons and has performed well over 8000 operative procedures in his clinical private practice.