Return of the Paper Chart

Week 2 of hospital cyberattack post-apocalyptical workflows.

While the EMR and many other associated systems, platforms, applications and connections remain down and/or intentionally offline, sweet memories of being a medicine intern and pathology resident with paper charts composed of 2 hole punch systems and indestructible binders have brought back good thoughts.

A time when all revolved around those odd colored binders containing paper charts with hand written notes, orders, consults, and care plans. Admission orders, discharge orders and the daily SOAP note is in play once again in a paper form without a lot of extraneous EMR stuff.

Anesthesia paper charting, brief op notes, long op notes, lab orders and more all on paper, recorded, read, followed, resulted and available in "the chart" for review.

As our old attendings used to say, "When I was a resident....". When I was a resident this is how you found clinical information, history, physical examination findings, radiology findings and laboratory results.

Life revolved around "the chart".

The older nurses would scold you if you didn't return it to the proper slot on the carousel; your residents and fellows would grab it from you while you were writing and the consultants would demand seeing it, even if that meant suspending your SOAP note or page 3 of 14 of your handwritten discharge summary for some other poor house staff who had to take the case on transfer.

Medical students were eventually allowed, by the time of your sub-internship to take "the chart" into the charting area with days old doughnuts and leftover spinach dip. If a cute young nurse was looking for a chart, you would help her. If you had the chart she was looking for, you gladly said she could use it and return it when she had a few minutes to discuss the case.

The paper chart and the indestructible binders which contain them are alive!

Take that cut and paste notes and MyChart and multiple screens and apps and electronic order entry and results!