EPtalk by Dr. Jayne 3/12/15

I mentioned in Monday’s Curbside Consult that I took some time off from my day job this week to immerse myself in the routine at my new moonlighting gig. I also used some of the time yesterday to finish my tax return. As I went to put my documentation in the file cabinet, I realized that the drawer was full and I should probably spend some time dealing with some non-hospital document retention.

At work, we’re rabid about document retention. We keep everything exactly as long as required by laws or regulations, and then it’s off to the physical or virtual shredder. There’s a certain liability in keeping things longer than you need to, and as a risk-averse organization, we don’t want to shoulder any more liability than required. I definitely had files at home that were well past the need for retention, so I started culling through them. The amount of document detritus that can accumulate over a physician’s career is pretty impressive.

In addition to the usual household paperwork such as tax documentation, financial paperwork, mortgage paperwork, and important receipts, physicians have a host of other documents to manage. If you’re lucky enough to work for the same employer for most of your career it might not be too bad, but for those of us that have worked for several groups, the paper carnage can be impressive.

I’m not even talking about patient records or office-related information – just the personal ones. There are medical liability insurance documents, payer credentialing documents, hospital privilege documents, employment contracts, CME documentation, licenses, and DEA and state narcotics documents. There are college and medical transcripts, records of licensing exams, diplomas (and their certified translations if you went to a Latin-loving med school like I did), board certification documents, and now maintenance of certification documentation.

The pile was impressive. For conventional financial documents, there are retention standards. Some of the professional documents need to be kept for even longer, especially if they relate to liability insurance. I’m not going to rely on a former employer to prove that I had liability coverage if a claim occurs at the end of the statute of limitations. With the prevalence of identity theft, I’m not going to get rid of some of my original documents that relate to licensing or board certification. I was, however, able to weed out quite a bit of documentation and reduce the pile. Now that it’s more organized I should scan it all, but that’s a project for another day.

After I made it through the “official” file drawers, I turned to some of the documents I had kept for more personal reasons. It was a reverse chronological tour through what it takes to become a doctor. I started with student loan payoff documents and worked my way back through the application to defer payment during residency and the heart-stopping promissory notes I originally signed as a 22-year-old. I distinctly remember the day I signed the first one – if nothing motivates you to not wash out of medical school, it’s the possibility that you could have upwards of $200K in debt with no way to repay it.

The tour down memory lane also included rejection letters from a handful of medical schools and acceptance letters from others, as well as my original Association of American Medical Colleges application packet. Back in the days of the typewriter, I had filled it out by hand first and then typed it up. Both copies were there and it was funny to think about doing business without the now-familiar fillable PDF or online form. Reading the essay made me smile – it was a good reminder of youthful optimism, untarnished by E&M coding regulations, fear of litigation, or Meaningful Use.

One might ask why I still had all that. Although I do probably tend to be overly sentimental, I think it is more due to the realities of rushing from college to medical school to residency to solo practice without a break. The boxes just moved from one tiny student apartment to another and then to a house. With the crazy hours we work, as long as you have space to keep it, there’s little motivation to spend your free time sorting it all out. It got me thinking about the volume of electronic documents I might have, where space is not a limitation.

For good or bad, my hospital has a fairly liberal retention policy for email. A CMIO buddy of mine works at a hospital where all emails delete after three months and they have limited archive space allotted, so he’s constantly having to either save emails to other file formats or risk deletion. I try not to keep email too long but there’s never time to sit down and clean it out. I realized I hadn’t purged my archive folder in what looked like about two years. I spent a couple of hours deleting tens of thousands of emails. In that history were both the mundane and the heroic. I looked back fondly on standing up the region’s first HIE, but with the bittersweet sense that it is now defunct.

Those electronic missives tell the story of hundreds of thousands of hours of work. Not only by the IT teams, but also by the clinicians and other end users that did the work alongside us, whether enthusiastically or reluctantly. I know the emails needed to go and it was somewhat cathartic to watch those massive chunks of data disappear from my folders. On the other hand, it made me miss the simpler days when our main goal was to do the right thing by our patients rather than checking boxes and counting measures.

I enjoyed being reminded of colleagues who have moved on to bigger and better things as well as some pretty crazy stories. The hail storm that struck during one of our EHR design sessions, totaling cars. The analyst who ran our first EHR upgrade and slept at the office all night in a folding lawn chair while the rest of us went to our vendor’s user group meeting (bad plan, by the way). The vendor rep who got food poisoning during a site visit and still called in to our meetings while lying on the hotel bathroom floor (that’s dedication). Team-building tricycle races, cosmic bowling, and mini golf. And the software developer who put up with my newbie questions and helped me bring a feature live that no one else seemed to care about but that made a huge difference for our users.

Those are not exactly the stories you memorialize in a scrapbook but I’m grateful for the memories and to everyone who has helped me along the way. We may not always have Paris, but we’ll have the EHR.

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