Purpose: To assess the implications on workflow and efficiency in a paperless environment versus a traditional paper-based environment. This paper summarises the comparison of specific workflow practices conducted in a paperless and paper-based approach, comparing time taken, potential advantages and disadvantages of each approach, and the cost-effectiveness of a paperless approach.Methods and materials: A time study was undertaken on three specific workflow areas for 5 patients with breast and prostate cancer respectively, and comparison made between paperless and paper-based methodology. The workflow areas analysed were electronic treatment record (ETR) versus treatment sheet preparation, digital history check process versus paper-based and digital image and trend analysis versus paper-based. The cost-effectiveness of a paperless approach was then analysed. Additionally a staff questionnaire was undertaken, assessing Information Technology (IT) skills of staff and comfort levels pertaining to a paperless environment.Results: There was on average a 50% reduction in workload when comparing an ETR versus a paper-based treatment sheet, a 50% reduction in workload by utilising a paperless history check process and a 70% reduction in workload with a paperless image and trend analysis process. There was also significant cost savings by introducing a paperless workflow. The survey showed a higher level of comfort with information technology in the paperless environment, and less frustration with aspects of working in the paper-based centre. Conclusion: The digital radiotherapy department offers highly significant improvements in efficiency. These potentially translate into major financial savings and increased job satisfaction.
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