Well, here are mine. Remember, many of these tasks rely on the speed (or lack thereof) of the computer program, printers and network, which is far from instantaneous.

I have to type or select orders, select the person to carry it out, then print the order to be sent to the hospital (select printer, print, walk down the hall...). (Previously, used pre-printed sheet, assistant did all the work).

Documenting is substantially more time consuming than picking up a microphone, identifying the patient and dictating a note. My practice does not lend itself well to templating (may too many unique problems, very few single common problems).

Fax and lab management... previously was written slip in the inbox, looked at it, initialed it, put in outbox. Now it is go to fax program, open fax, associate with patient, import and sign off, each step of which takes more or less time depending on the network speed at the time.

Prescriptions... I like e-prescribing, but selecting the pharmacy each time, finding the right one, or else selecting the printer, sending to the printer and waiting for the printer to print, then getting up and walking down the hall to the printer is much more time consuming than writing on a pad or telling my assistant to call something in.

Coding. Now it is completely up to me. We have a well trained coder in the office who now spends her time keeping computers running. We use an awful lot of codes, far too many to keep in my head. I used to just write down what the Dx was and the coder took it from there.

Each part of the charting and billing process takes longer than doing it manually. No part can be set in motion to complete itself while I go on to do some other task; multitasking is a thing of the past. Is it more precise and accurate? Probably. Is it more efficient? No.


David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands