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Unhappy Camper, Vol. 2, Issue 1

A fellow pediatrician while rounding at one of our local hospitals recently encountered significantly difficulty in accessing a computer terminal in order to enter her progress notes and CPOE. While each nursing station had four such machines, the timing of her visit was apparently inopportune since each terminal was busy with other medical professionals using them. There was, in fact, a line forming just to get access. Many, if not most, physicians do their morning rounds between 7 to 9 am in the morning, which is also a time when many residents are entering their morning computer progress notes. Nurses, physical therapists, respiratory therapists and every sort of medical professional may also be needing access to these computers at the same time and at the same place.

But what was particularly alarming was the fact that many people who leave the terminals do so with the intention of returning in a very short amount of time, so that they can check on some small thing or another, and they can get very upset if another person sits down and starts using that same computer for their own use. No protocols exist that I know of that give standards of etiquette on how to share these infernal machines nicely with each other.

So the following day when it was my turn to round I surveyed some of these nursing stations at two hospitals. Low and behold, what I discovered that about half of terminals with no one in the seat actually had users already logged on with their credentials and had access to patient information. The patient information was in some cases fully up on the screen, but in some cases was minimized down into the task bar. In one case another clinician was accessing the records on the same patient I had come to see. It would have been too easy for me to mistake the logged on user’s screen as being for myself and to inadvertently write my notes or orders with the other clinician’s credentials. It would have been quite easy not only to access the information on patients not my own, but also to have edited these records or entered orders at my whim all while using the credentials of the clinician who was actually logged on.

Had Britney Spears been an inpatient at this hospital I also could’ve looked up her files with impunity — well, at least towards myself. This actually happened in Los Angeles, after which several medical professionals were fired over such peeking, based on their logged-on status while accessing her medical records without a professional need-to-know.

Current medical-legal thinking is that when a clinician logs on with appropriate usernames and passwords, it becomes the equivalent of a legal signature for the information view and entered. But in the reality of the medical trenches, that is simply not the case when using systems designed as at the present.

Yes, I know, we all need to be diligent about logging off hospital EHR when we’re done. But the reality appears that it is very inconvenient for each medical professional to actually do so without disrupting essential work flows. We need better systems that recognize the realities of the hospital or large clinic settings.

One might propose a hot key that will instantly minimize and lock the screen that the clinician is using until a thumbprint scan brings it back up later without having to reenter the system de novo. User proximity fobs exist that unlock a computer with password security if a user sits in front of a computer. But I don’t know that these same fobs can lock the system back up when the user steps away. In order to be a reasonable option, this would need to be combined with instant on-access once returned. Biometric security features such as thumbprint scanners and security fobs are the only reasonable way I can foresee making log-ins (and log-offs) easy and more efficient for medical staff so that they will actually be used, and it’ll undoubtedly be an expensive fix.