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I watched a doctor engage with a dozen patients and then head to a PC to take notes. Doctors pride themselves on being smart people, but I harbor some serious doubts about the accuracy of this approach and I can't help but shake the notion that the first patient they saw might not have all of the pertinent information recorded an hour or two after the exam.

We used to have a solution to this: Clipboards. But I can't remember the last time I saw a doctor in my org carrying a clipboard.

The solution my mother trained to perform: shorthand-using assistants, with further training in medical jargon and drug names and such. They'd follow the doctors around and take notes, so the doctor could focus on the parts of their job that couldn't be done by someone with a year or two of junior college training.

Is that still done? I've seen one doctor do it, and the assistant was typing.

I don't think it's common now, but it used to be a really common type of job.

Basically all those secretarial-type jobs—which used to be quite a bit of the workforce—went away, replaced by making experts use computers themselves, to enter data into usually-shitty-and-time-wasting systems. It's my understanding that a lot of the folks who are old enough to have done both despise the new system.

Many of the doctors I have interacted with at Kaiser refuse to use the computer and ask someone else to come enter the notes and data while they examine me or my wife.

Many of the doctors I have interacted with at Kaiser refuse to use the computer and ask someone else to come enter the notes and data while they examine me or my wife.

My mom had a job like this at a big bank.

The first thing she would do each morning is print out the e-mails for one of the V.P.'s.

The last thing she would do in the afternoon is take the dictation of his replies, and then send them as e-mails.

It's one of the reasons I roll my eyes when I see people on TV and the internet pretending to be "rich" with their multi-thousand dollar cell phones and gadgets.

Really rich people, and I mean really rich people, barely use electronics. They have people to do those things for them.

Pretty sure Jeff Bezos, Bill Gates, and Elon Musk use a lot of electronics.

Three out of thousands.

Yes, the position is called scribe.

I thought the position was called Jonathan, but the title was scribe?

Serious question, would clipboards meet current compliance requirements? There's no authentication, no audit trail, etc.

The information would have to be transcribed to the EMR, but otherwise many practitioners use written notes to fill the gap until they can document in EMR. I've also worked in facilities where certain medical paperwork was only kept in paper form and never uploaded to EMR, which I thought was insane when it comes to the concerns you've mentioned.

That's because thanks to computers, clipboards are no longer needed.

That's because thanks to computers, clipboards are no longer needed.

But the whole point of this thread is that the computers aren't getting the job done.

So why not use something has been proven to work, rather than something that is showing that it doesn't work?

It's my strong suspicion that the majority of computerized replacements for human and pen-n-paper predecessors are either a wash in terms of productivity, or actually make things worse, and it only looks like the computer revolution was a huge boon for productivity because it improved a few areas a ton.

Computers are great at replacing those filling cabinets, and when you need to track a single piece of information over a lot of people or a lot of time. Other uses in an office aren't as transformative.

Sorry, clearly I confused you. I was being sarcastic. I should have made that obvious (e.g. with /s etc).

I’m yet to experience a long clipboard outage.

EMT here. We still use clipboards in the field on 911 calls. I can fill out a paper patient report in real time while I talk to the patient. Transcribing it into the EMR on the computer later takes about 45 minutes.

Some of our peer services use tablets in the field. I hope we never switch over. Besides the nightmare of the horrible UI (because that's always the case with enterprise software), if the batteries die or you try to use them outdoors in bright sun, you're hosed.

> I harbor some serious doubts about the accuracy of this approach and I can't help but shake the notion that the first patient they saw might not have all of the pertinent information recorded an hour or two after the exam.

You would be correct.

> Finally, as an overall generalization, doctors don't like being told what to do or how to do it, and that goes double for computers. They don't care about your needs to maintain a secure IT platform and will do anything in their power to circumvent anything that they don't personal feel is necessary. Better to engage them early in the process, figure out their patterns, and learn how to work with them because going up against them is likely to be a losing battle.

I'll give the opposite advice: engage with the buyer. At the end of the contract, he's the one paying and deciding whether or not the software is worth something. Sadly, the objectives of the buyer might not completely align with the provider, but that's an internal issue: as a consultant and an external contractor there's very little you can do. Also, never work for a healthcare organization as an FTE.

Some physicians dictate chart notes as they walk from one patient's room to the next.