If the nurse at the hospital was surprised to see me, a senior physician, groveling under a desk outside a patient’s room, she hid her reaction nicely. Maybe she assumed that I had lost a contact lens, pen, stethoscope, pager, or my sanity. Maybe she thought I just wanted to commune with dust bunnies, or perhaps she had grown accustomed to people doing strange things where computers are concerned.
My technological woes at the hospital began a year or two ago when the Information Technology people at the hospital made a great leap of progress and prowess called the "simplified sign in" (SSI). In the dark ages of computing, people needed to have about 101 passwords for everything from the electronic medical records (EMR) system to the water fountain. To maintain proper cyber security, all 101 passwords needed to be changed every month. To simplify this password morass, SSI put a small plastic medallion on the back of my hospital photo ID. To access the EMR I just swipe my ID badge over a small gizmo with a red LED connected to the hospital computers. The gizmo is supposed to give a welcome beep and let me use the EMR without the need for passwords. Or at least I thought that was the goal of the exercise.
Dr. Larry Greenbaum
Keep in mind that accessing the EMR is a necessity for patient care. In the bygone days of paper medical records, doing a hospital consult involved flipping a lot of pages in a fat chart. Now almost all the information a consultant might need, such as labs results, x-ray reports, findings from history and physical, consult notes, nursing notes, therapy notes, medication lists, and even vital signs are locked up in the EMR. Without access to the EMR, I am unable to offer my learned consultation.
Actually the SSI doesn’t obviate the need for a password, or the endless need for updating passwords. Swiping my ID brings up a sign-in window, and I still have to type in my user name and password. It took me forever to get the little medallion for the back of my ID, because of the erratic hours I keep at the hospital. I avoid the place when possible. When I finally figured out that SSI was just another technological annoyance factor, I felt cheated. The term simplified a euphemism. In reality, SSI made getting into the hospital computer more complicated instead of easier.
On my most recent visit to the hospital, I marched in with grim resolution to face another round of technological humiliation when I remembered that I had my stethoscope, but I didn’t have my hospital ID badge with the plastic medallion. Without the SSI medallion, I would be locked out of the EMR, and doing a consultation would be impossible. So I made myself march out of the hospital and back to the parking lot to get my ID from my briefcase. I consoled myself with the thought that I needed the exercise anyway, even if I didn’t want it.
Trudging back through the hospital tightly clutching my beloved ID, I made my way to the unit of the patient I needed to see. Almost always, the patients I need to see are at the end of a long hall, and tonight wasn’t an exception. I’ve always admired modern units that have a radial design with each patient’s room equidistant from a central nurse’s station. Equidistant seems like such a charming phrase when you are dragging yourself down a long hallway late in the day. Although my hospital is blessed with SSI, the corridors are long serpentine mazes. Maybe the architect was having a bad day when he designed the place.
I finally got to the far end of the hallway and found my patient’s room. Outside each room is a desk attached to the wall, with computers for the doctors and nurses to use. I swiped my ID card, reached the sign-in screen, typed in my user ID and password, and clicked "log-in." After a long pause, one of those angry-looking boxes with a big red X said I "couldn’t be authenticated." Although I felt authentically tired and frustrated, I tried to reason with the stubborn machine. After a few more futile tries I had a sinking feeling that SSI just didn’t like me.
My next step was to call the hospital’s computer help desk. The hospital operator rang the number right away. Surprised that I had reached a human being so quickly (rather than voice mail), I blurted out my problem. Unfortunately, it was the wrong number. The voice on the other end of the line added, "This is Jennifer’s daughter." I had no idea who Jennifer and her daughter were, but I think the operator connected me to a patient’s room, and I can only imagine what this family thought about getting a phone call from a befuddled physician trying to break into the hospital computer system.