KitNewCare Case Study: Paperless Transformation - Digital Lab Results, Electronic Medical Orders, and Electronic Signatures

This project was undertaken at Warszawski Uniwersytet Medyczny Hospital as part of the KitNewCare project. 

Team members 

Zuzanna Jakubowska¹ 

Małgorzata Kępska Dzilińska¹

Ewa Wojtaszek¹

Jolanta Małyszko¹

Paweł Żebrowski¹

Urszula Jabłońska²

Jarosław Gopek³

1 physician, nephrologist

2 nurse 

3 administrative worker / finance professional

Life Cycle Assessment Support 

Life Cycle Assessments were conducted by Dr James Larkin, Postdoctoral Researcher and Sustainability Officer at Trinity College Dublin.

Setting/ patient group

The centre provides dialysis treatment to approximately 90 patients and employs a team of 5 doctors and 12 nurses. Before the intervention, each patient generated an average of 100 printed pages per year. 

Additionally, the project extends to the Nephrology Department, which operates with an estimated 1,000 patient-days per month. Each of these patient-days requires multiple medical orders, making a streamlined, paperless process essential for improving efficiency and reducing administrative workload. 

Issue

The haemodialysis department relied heavily on paper-based lab result printing and medical orders, leading to excessive paper waste, increased costs, and inefficiencies in doctor-patient interactions

Intervention 

The project supported the transition to a paperless workflow within the nephrology and haemodialysis departments. Key activities included upgrading digital infrastructure, introducing electronic access to laboratory results and medical orders, and providing staff training and technical support. Progress was monitored through staff and patient feedback, alongside measures of paper use and workflow efficiency. A second phase explored the introduction of electronic signatures to further reduce paper-based documentation and streamline clinical processes.

Outcomes

Patient

No negative clinical or organisational effects were observed following the transition to electronic documentation. Patients continued to receive results and medical information without delays, and no disruptions in diagnostic or therapeutic processes were reported. 

Environmental 

The move to a predominantly digital workflow reduced paper use by approximately 13,000 pages per year and eliminated the need for around two toner cartridges annually. This was associated with an estimated reduction of 195.19 kg CO₂e and 128.83 m³ water use impact per year, equivalent to approximately 2.17 kg CO₂e and 1.43 m³ water savings per haemodialysis patient annually.

Economic 

The intervention generated direct savings of approximately 1,430 PLN (€338) per year through reduced paper and toner use. The greatest benefit came from improved efficiency, with the equivalent of 12 working days per year of specialist or resident time freed up through the elimination of paper-based processes.

Social

The estimated social impact, measured as forced labour medium-risk hours, decreased by approximately 65.67 hours annually. Staff also reported improved workflow efficiency, easier access to information, and reduced administrative burden associated with printing and paper-based documentation.

Summary

The transition to digital lab results, electronic medical orders, and partial adoption of electronic signatures significantly reduced paper use, increased workflow efficiency, and aligned the department with sustainability goals. These outcomes directly addressed the project’s aims of reducing waste, improving staff efficiency, and modernising documentation processes. 

Key elements contributing to success included: 

1. strong leadership support and clear policy direction, 

2. adequate digital infrastructure (Wi-Fi, tablets, secure EHR access), 

3. staff willingness to adopt new workflows, integration of changes directly into everyday clinical routines.