Paper still vital for docs in a digital age
Doctors are still reliant on paper to record vital information about patients according to this opinion piece in the New York Times, and thanks to hastily constructed EHR networks, and a slew of poorly designed mandatory reporting systems, its a growing trend amongst healthcare professionals; despite a 65% growth in the numbers of hospitals offering EHR facilities in the last 7 years. In the author's case, ironically part of this paper reliance is down to a feature in the EHR system: every time a patient record is amended, the record is printed off, an option that cannot be disabled.  

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As the ancient Britons celebrated the alignment of stone and shadow at Stonehenge, as modern astronomers delight in a solar eclipse, so joy fills my personal universe during the brief intervals when my three major professional passwords converge.

I use each one dozens of times a day to access the hospital systems necessary to write notes and prescriptions and check labs and email. The passwords must be changed every three, four and six months, and I have a strategy for updating each one. But their different rotation rates mean that one or another always needs attention, sapping my concentration and occasionally precipitating disaster. (“Too many unsuccessful attempts! Contact administrator!”)

And then along come the halcyon weeks when they are all exactly the same, a time when mind and fingers fly and I get to think about other things, like the patients in front of me.

In addition to those three passwords, I have quite a few others: one for our old collection of electronic records (whose information cannot be transferred to our present database), two for separate lab computers not connected to the main computer, one for the billing system, one for mandatory online educational activities, one for the residents’ schedule and evaluations. Most of these have their own slow cycles of renewal; I keep track of their rotations on a tattered index card in my pocket.

And I should be grateful for the passwords I do have, because there are quite a few I do not have. For instance, I have no access to the separate electronic records used in our emergency room, so I have little idea what goes on with patients there until they surface somewhere within my digital range. I have no access to yet another system used by most of our outpatient consultants (and they have no access to ours).

Who knows what the biblical stonemasons sang to themselves during work hours at their Tower of Babel. This is the soundtrack at ours: “What exactly did the kidney guy tell you to do?” “Are you sure?” “How did the ER explain that?” “Could you just bring in the new pills next time?”

As it says in Genesis, humans who speak the same language do reasonably well until a higher power makes a series of panicky, poorly thought out software purchases, at which point all productive collaboration grinds to a halt.

In 2009, fewer than 10 percent of hospitals had any kind of electronic medical records. By 2014, 75 percent had at least a basic system, all rushing to comply with the mandate for electronic transactions contained in the Affordable Care Act.

The data do not indicate how many, like ours, are now awash in the products of competing vendors whose proprietary coding specifically impedes inter-system collaboration. Nor are there yet any algorithms for untangling the wires of a system as rich in different languages as ours.

The rush to electronic information was prompted by the best intentions. According to the Department of Health and Human Services, “using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.”

No one in our Tower debates those goals; we struggle daily to accomplish them, and often, incredibly, we succeed.

We succeed with the simple expedient of paper.

Paper has become our lingua franca, our fallback and standby. In our new digital universe, we have peculiarly seen a retro explosion of paper. We may no longer write paper prescriptions, but we fax or hand-deliver paper versions of our electronic dealings routinely now. When you don’t know what electronic language the receiver speaks (and you never do), you go with paper.

Furthermore, one of our systems automatically prints out a paper health summary for every patient we see — even for patients who have established a confidential electronic portal into the system. We cannot seem to turn the print feature off. We press these summaries into our patients’ hands or, if they say no thanks, we leave the sheets in the printer to be shredded. That’s about a ream of paper a day right there.

A few months ago, on a day when morphing passwords had messed up my entire morning, I stopped in the public ladies’ room next to our work space. There, teetering atop the trash can, was one of these paper summaries. It contained (in boldface type) the name, address, date of birth and medical record number of one of my patients, her medical diagnoses, prescriptions, next appointments, and her own ultrasecret password to set up that confidential patient portal.

So much for the secure exchange of health information, so much for the best electronic intentions, so much for whatever order and control are implied by all those passwords. I could hear the arches of our poor tower crack just a little more. I folded the papers into my pocket so I could put them in the shred pile later.