Dear IT,

I know that, on many levels, physicians must be the absolute banes of your existence.  We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems.  We call you because we forgot our passwords, then because we forgot the new passwords.  We call because the system crashes and we call because the voice recognition doesn’t work and we curse the screen and shake our collective fists at things that slow us every day.   I get it.

However, there are some things that you and those who develop your systems need to understand.  Allow me to elucidate.

We didn’t ask for EMR in its current incarnation.  It is now a gargantuan billing and data collection industry, with precious little utility in our day to day practices.  As such, your bosses love it because it squeezes the last gasping penny out of every chart.  They write your checks, we don’t.  Nevertheless, we have difficulty being excited about ever more fields to fill out, ever more time-stamps, ever more screening exams, and the caucophanous symphony of key-strokes and mouse clicks that echo through the modern hospital and threaten to muffle the sound of suffering and human interaction.

Next, passwords and security make a lot of sense to you.  You dwell in a world of hackers and identity theft and you worship at the silicon altar of HIPAA.  We, however, are busily seeing patients and trying to do it as quickly as possible in hospitals, clinics and especially ER’s that have no ‘off’ switch but which do track our ‘quality’ in part by tracking our speed and efficiency.  Thus, we have little time to spend logging on.  And when we step away to, say, intubate a dying patient, the last thing we want to do is log back on to 1) the computer 2) the hospital EMR system and 3) the particular department system and 4) the radiology viewing system.  But here’s the really, really important part:  nobody is busily stalking behind us trying to look at medical records or interpret xrays on strangers so that they can violate their privacy.  We’re watching; trust me.

It was a nice idea but now it’s a poison. It is the law of unintended consequences on steroids. It’s all redundant, irrelevant, obnoxious busy work that stands between us and efficiency.  If you really insist on it, then make it all biometric with thumb prints. Because tracking usernames and passwords is starting to take up more of our fragile brains than drug doses and diagnoses.  And that, my friends, is not good.

Now, about tech support and system back-ups.  We have to use these systems.  There is no option.  And we have to use them 24/7/365.  Because that’s when people get sick and die.  Therefore, every system needs to have a parallel back up system that kicks in whenever a data transfer or update or repair or anything else is happening.  ‘We’ll be shutting down for four hours’ isn’t an option anymore.  Since ‘we won’t see heart attacks for four hours’ isn’t an option either.  Furthermore, when things are going badly, when we need a reset password or when the computers are locked up in some loop that looks like an alien language, we need help immediately. We don’t need ‘a ticket’ submitted.  A round-the-clock job that requires EMR necessitates round-the-clock IT.   No questions asked.

Finally, to those who design these monstrosities and those who buy them to the protests of clinicians, what are you thinking?  Medicine is about caring for patients. And anything you create that makes it more difficult is an insult.  Shame on you.  You should do better, for your staff and for the patients who ultimately pay your salaries and fees.

And for you IT folks, I’m sorry.  I’ll keep trying to do better.  I generally know where to find ‘start’ when I’m talking to you and I can actually navigate the directions you give in a fairly efficient manner.  I know that the disc drive isn’t a cup-holder and that I have  PC, not a Mac.  I’ve even been storing my passwords on my smart phone!  I realize you have a tough job; made tougher for dealing with physicians and nurses.

All I’m saying is this:  I understand your frustrations.  Try to understand ours!



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