Why I like paper:
I have patients, especially the older ones, who complain to me that they do not like my staring at a computer and talking to them. They prefer eye contact. One of the hospitals I belong to had a meeting a few months ago about improving our grades. One suggestion is learning how to use the computers without looking at the screen. I am not sure how to check boxes when I do not know where the cursor is. I was “encouraged” to purchase my office computer a few years back via one hospital’s physician organization. They included all the necessary grades to include the quality measurement criteria (PQRS). I just got my report card and found that I am only 14% participating. The criteria they chose for me are not those of my specialty, so I did not do them. There goes the 2% penalty from the government. I just got back from a meeting on hospital computers. The issue is that when someone goes from rehab to the acute side for a test or workup, they will be discharged and then readmitted. This satisfies the IT department as the only way it can work. However, this means we will have a ton of same day or next day readmissions and this looks lousy on quality.
I used to write admitting orders on paper and place them in a drawer. The nurses would open the drawer and start the orders. They would call me if there were any changes or inconsistencies (which may occur after I write orders and then the patient is discharged later). Now, I cannot write orders on the patients until they are officially admitted or preadmitted. Sometimes they are the same. In theory, I can write my orders remotely with the computer. In fact, often the computer in my home will not allow me access to the chart. The other hospital requires a special encryption in my computer. Therefore, I cannot write orders sometimes at night, or at a different hospital, etc, or shopping, etc. I may drive back and forth between 2 hospitals (35 miles apart) 2 or 3 times a day and at night (had to do this after midnight once, and then got dinged that it was not done on the same date that the patient arrived). Other times, the orders were accidentally deleted and I have to reenter by computer. I gather this is somehow more efficient than using pen and paper. I wonder if I argue that the gas I used (which is expensive) is increasing my carbon foot print and for environmental reasons I should go back to paper. Then again, I probably would be told to get an electric car to go with the EHR.
Lastly, rehab is a small specialty. My call group goes back 20 years with coverage at multiple hospitals. Each has a different computer system. Now that we are paperless, none of my call group will cover me as they do not want to learn another computer system for a few days, and then forget it over the year. The hospital will not let me have them cover until they show competency and take a day off from their practices to train. So I am required to go to a meeting but may not have coverage.
On the flip side, there were problems reading my handwriting, but I solved this by typing my orders before putting them in a drawer.
Now before anyone links me with the Unibomber, I took basic computer training as a premed in the 60s. I foresaw the role of computers but not to the extent that occurred. I believe in telling the emperor he has no clothes. My wife feels I am just a misanthrope. She said, teachers have gone through this already, and we should face it that doctor means “teacher”.Tweet