Cartoon of guy whacking the copier
Since going paperless little more than a month ago, the Joint Department of Medical Imaging has emailed more than 60,000 imaging reports to providers, which translates into about 120,000 sheets of paper saved. (Source:

In the 1999 satirical comedy Office Space, the movie's three main characters have an office printer that keeps malfunctioning. At their wits' end, they vent their frustration by taking the printer to an empty field and mercilessly attacking it.

By the end of the scene, the printer is left alone in the field, shattered to pieces.

Technology is wonderful.  It can greatly improve our processes and help create efficiencies. However, on the flip-side, if processes are not kept current and up-to-date, technology can cause costly delays, workarounds and even errors.

Last year, Toronto's Joint Department of Medical Imaging (JDMI), part of the University Health Network (UHN), Sinai Health System (SHS) and Women's College Hospital (WCH), was faced with a reliance on outdated processing by its hospital organizations. The result was 44 faxing incidents, such as a missed follow-up and privacy issues, and one critical incident, which resulted in patient harm. 

"Fax and snail mail are no longer reliable mediums for communicating important information in the 21st century," says Leon Goonaratne, Senior Director of Imaging Informatics, JDMI. "We have a responsibility to our patients, providers and the environment to move away from paper, and towards safer, paperless communication."

Huge paper savings in first month

Stopping short of taking out baseball bats and charging at the fax machines, the JDMI decided to discontinue faxing and paper mailing of imaging reports to more than 850 physicians at UHN, SHS and WCH.

In line with UHN's Caring Safely program, JDMI stopped faxing and paper mailing of imaging reports to internal physicians and nurse practitioners on April 1. As an alternate form of receiving imaging reports, the JDMI offered a new option to its users - email report delivery.

While health providers will continue to receive their patients' imaging reports in the HIS (Hospital Information System), they can now register to receive reports via email, directly into their secure mailbox.

In little more than a month, the team has emailed more than 60,000 imaging reports to providers – translating into about 120,000 sheets of paper saved. And this is just the start.

"We anticipate the number of reports sent via email to go up quite significantly," says Leon. "More and more internal referrers are registering each day, enabling us to have their up-to-date contact details, and delivery method preference."

More than a year in the planning

Planning for the JDMI's move away from fax and mail started in early 2016, where the team organized a working group and piloted the email report delivery with early adopters from UHN, SHS and WCH. They recruited high-volume referrers that received their imaging reports through fax.

The working group corresponded with these clinicians, listened to feedback, and worked on an updated version that incorporated their suggestions.

Once the product was "show ready" it was made available to all referrers, organization-wide.

"This was a difficult change for us to embark on, because of the reliance our hospitals have developed on fax," says Dr. Larry White, Radiologist in Chief, JDMI. "However, after only a few weeks being off fax, the results are resounding.

"Everything from the positive feedback received from new users of email report delivery, to the amount of paper we are now saving. This proves, just because it's new, doesn't mean it's bad." 

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