Why do you say CPOE is clerical work?

“We can’t do that, they’re trying to get us to do clerical work.” – Physician overheard talking about electronic order entry and documentation

It’s an interesting observation that bears a little reflection, how did it come to pass that direct entry of an order into a computer, or typing in documentation become a clerical job?  How did using computers for these tasks become considered beneath the scope of a professional?  If history can shine any light on this, it is to uncover a bias that borders on classism and sexism.

Until the early 20^th century, in contemporary Canadian culture, almost all professionals were men.  Middle-class women mostly worked in the home, raising the family or working on the family farm.  The exceptions were unmarried, usually younger women who could work in jobs that did not require as much time for education (as their working years often amounted to only a few before they were married).  So it came to be that medical office assistants and other clerical roles became associated as predominantly female jobs.  Now, even though much has changed with many women working in professional careers and men working in these traditionally female jobs, there still seems to be some of the legacy of these old divisions of labour that remain.

My father was a mathematician and was in fact, one of the first computer programmers in Canada.  He had been a student at UBC and was offered an opportunity in the mid 1950s to go out to U of T to work on programming the FERUT, a very expensive early computer.  One of the things that surprised me about his story was that he told me that – even though mathematics was a highly competitive and very male dominated field at that time – computer science was not.  In fact, many of the early computer science pioneers were female.

Beatrice (Trixie) Worsley was one of the first programmers in Canada.  She had trained with Alan Turing at Cambridge, UK where he was working after deciphering the German’s Enigma Code in WW2.   She was one of several women who met my father and guided him through his programming efforts.  I later asked my father why he felt the other mathematicians were not rushing over to learn about computers and he told me that many found it too clerical.  From the 1950s and 1960s, men tended to want to work with and design the machines and considered the programming as more of a female role.

Gradually, with the advent of the personal computer and next with the growing gamer culture, computer science and computer gaming became more and more a male dominated industry.  Today, 47% of the whole adult workforce in North America is female.  In contrast only 30% of Google, 29% of Microsoft, and 31% of Apple employees are female.  When looking at technical jobs, 80% of the people Apple hires currently are men.

So the question I ask is, is the perception that electronic health records are forcing doctors to do more clerical work based on anything other than historical prejudice?

Computerized order entry is simply more efficient than the historical paper process.  Consider the time it takes doing it the old way: a physician writes an order, holds on to the chart while finishing what s/he’s doing, carries the chart to the unit clerk where it sits in a bin until it’s transcribed and sent to the lab, pharmacy etc.  There is an obvious loss of efficiency and delay in that system.  In contrast, direct order entry sends the order immediately (point, click, enter, done), possibly done while the physician is still with the patient.  Similarly directly inputting documentation in a legible and immediately universally accessible format adds more intrinsic value to the patient’s record than a single minimally accessible often barely readable paper based record.  It is a cognitive error to assume that just because a given task reminds you of something a non-professional can do, that it is inherently non-professional. 

We may never be able to achieve perfect balance in gender equality.  There will always be differences between men and women.  But to berate a task because it was at one point in history associated with a subservient, female or clerical role, is insulting and a disgrace not only to the women pioneers of computer science but also to the those individuals we all rely on to perform those important “clerical” roles.