The dev team went out "into the field" to help roll out the software to the company. This also allowed us to see how others used the software.
At the end of the day, one of the devs reported back that one personal assistant would maximize the email app's window (back when 17" CRT monitors were large) and after each email was processed, she'd print out the email and file it the appropriate spot in a filing cabinet.
All the devs were, "But... But... she can just file the email in an email folder in the program. Why does she need hardcopy? Email was supposed to save trees!"
Anyway I remember we used to write our weekly emails on paper first and then type them into the computer- your quote reminded me of that!
One of the chairs would read emails on his iMac, then would handwrite a return message and give it to my wife who would type it into email and send it as him. He didn’t want to type anything. This was around 2008 to give you an idea of timing. My wife didn’t stay for long, but my understanding is he was doing this until he retired sometime in the 20 teens.
The archiving software in this area is quite obnoxious and user unfriendly, so it happens every now and then that counties or government agencies decide to just print the lot of it on paper and put it in physical archives.
But I do remember going back to the 90s that there was at least one senior exec at a computer company I worked for who basically didn't touch his terminal as I understand it. His admin printed out and typed everything.
They're not entirely wrong in this regard - modern EMR web UIs are arguably inferior in many ways to some light pen driven systems of the 1970s-80s (I'm thinking especially of the old TDS system, which nurses (and the few docs that used them) loved because it was so easy and quick - replacing or "upgrading" it was like pulling teeth, and the nurses fought hard to keep it in every case I ever saw.)
Old habits take a while to change. Managers and executives were used to reports and memos on paper. So when email arrived, it was very common for secretaries to print emails for their bosses to read. Even at one of my early jobs in the 1990s, changes deployed to production had to be documented in memo form, and a copy of the memo printed, along with diffs of the code changes, and filed in a filing cabinet.
We got there eventually. I'd say that for all but the oldest generation still working, printing any kind of document to hardcopy has become pretty rare, at least where I'm working.
They demanded that their 'engineers' must be able to build out and manage both their own and their managed infra on AWS but never write any code - in fact they thought automation was outright dangerous, they said their engineers would never write any terraform, cloud formation or similar and that they wanted to become a MSP of cloud services preferring to write everything down in runbooks... and print those runbooks out.
The managers would turn up to meetings with huge stacks of paper that were just AWS documentation converted to pdf and printed.
We refused to work with them and essentially walked out. I'm sure this is something that someone like an Accenture or Deloitte would and probably did jump on.
This was 2019.
https://www.scribeamerica.com/what-is-a-medical-scribe/
The TDS Health Care System had some unique advantages but unfortunately it was tied to obsolete technology and ultimately a dead end. Web UIs aren't necessarily a problem. Some of the most popular EHRs such as Epic use native thick client applications. The fundamental issue is that healthcare is inherently more complex than almost any other business domain, with every medical specialty needing a different workflow plus beyond the clinical stuff there are extensive documentation requirements imposed by payers and government regulators. Sometimes clinicians and administrators insist on certain functionality even when it makes no sense due to ego or ignorance. EHRs can be improved but I know from painful experience how expensive and time consuming it is to get everything right.
When thinking back, it wasn't at all unreasonable at that time not to have used one, but it already seemed unfathomable.
It's one of those "the future is here, it's just not evenly distributed" (paraphrased after William Gibson)
When I was a kid my medical chart was paper. When I was around 13 years old the pediatrician’s office moved to an EMR.
It was more or less a digital version of the same chart.
As I have grown older, and with the benefit of having medical professionals in my family, I’ve seen how EMRs have changed from a distance. From an anecdotal perspective it seems like charting is more time consuming than it used to be. I’ve witnessed many different medical professionals using many different EMR platforms, and poor design seems to be a factor there.
They also deal with more information on a patient and in an aggregate form than paper charts ever did. From what I’ve observed I would venture a guess that more than a little of that is the result of neuroses and anal tendencies on the part of healthcare executives rather than quality improvement initiatives or research oriented objectives. There are other externalities like bad vendor implementation for CMMS requirements, or the continued granulation of conditions into ever more ICD codes, which then need crosswalk databases and interfaces and cross checks.
On the patient side, I’ve only ever truly been impressed by Epic’s portal. Every other one I’ve used is comparative garbage. I have recently been having a conversation with a manager at my doctor’s office trying to understand why and what changed so that chart data that used to be visible to me are now only visible to them, and why they can’t change that. It seems like the vendor implemented a forced change and I may just have to live with having ambiguously incomplete access to data I used to have access to, with no insight into what’s incomplete unless I already know.
With all of that said, at least there’s some access to one’s own health data. And comparing that to my birth records, which are functionally illegible (likely forever), at least what records are kept will be decipherable twenty years from now. Presuming they’re not mangled by a migration, which I’ve seen happen several times.