In an age when hospitals and health systems frantically race to implement EHRs to comply with government-mandated regulations, some physicians have a secret weapon to help them MacGyver their way around the technical shortcomings and excessive limitations of the password-protected technology: Paper.
"Paper has become our lingua franca, our fallback and standby," Abigal Zuger, MD, wrote in a Monday column on The New York Times' Well blog. "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."
Dr. Zuger uses three "major" passwords most often in her practice. These three are supplemented with a handful of others that aren't as pressing for her to remember, she wrote. However, they all need to be changed every so often, and it is a rare and beautiful thing when their cycles of renewal sync up, enabling her to remember just one password for all of her needs for a brief period of time.
In the meantime, she keeps track of their rotations analog-style, on an index card kept in a pocket. But as much of a headache as they are, Dr. Zuger appreciates them.
"I should be grateful for the passwords I do have, because there are quite a few I do not have," she wrote. "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)."
Beyond leveraging the "lingua franca" that is paper for remembering electronic passwords, Dr. Zuger finds that, for all of the bending over backwards that healthcare has accomplished for electronic records, one of her systems still automatically prints a summary on paper following a patient visit. This path off of the paper trail alone adds up to an estimated one ream per day, she wrote. In one instance, she passed by a trashcan where one of these patient summaries sat at the top of the pile.
"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," Dr. Zuger wrote. "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."