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Quite often (more often than not) when you hit "Print" from within our electronic health record, something happens.

Nothing.

Whether we're printing an after-visit summary, a test result that a patient wanted to take with them, a copy of our entire progress note to fax to an outside consulting physician, a referral, or a paper prescription for something like durable medical equipment, at our practice we often hit "Print" and then stare at a silent machine. Apparently, the way that things are set up from within the system, it doesn't work like it works at home when you hit "Print."

Instead of going from the keyboard to the computer, to the program, and then down the cable to your printer, the systems we use apparently are configured so that the print request actually leaves the building and goes off somewhere else, only to return when it learns the electronic designation and location of the printer it's supposed to be printing on. I can't really understand the mechanics of this, nor the reasoning, but I'm sure that whoever designed the system had their reasons -- something about handling the complexity of all the things we need to do within an EHR.

When we notice that a printer in an exam room isn't working (and have ensured no paper jam or empty paper tray), we're supposed to put in a work order request to the information technology teams, who can send another query to the tech administrative support group at the electronic health record vendor, who will then reestablish the connection, the electronic assignment, of that computer to that printer where it's supposed to send stuff to print.

But this breakdown of connection seems to happen almost every day, day in and day out, over and over again, and we're not sure what we're doing wrong on our end, if anything. We've asked our institution's IT team, as well as the support team from the EHR folks, and everyone says they'll look into it and get back to us. There are apparently better solutions, such as creating centralized printing, where everybody prints not in their exam room but in one central location, and we're currently looking into that as a way to streamline things and make the system less fragile, less prone to losing its connections.

But for years now, this has been a nagging issue at our practice. Our patients need a paper copy of a prescription to take to a DME vendor, a printout of a letter excusing them from jury duty, or a copy of the labs we did on them that they can take to another doctor outside of our system to show them. And every day we go hunting for a working printer, exam room to exam room, office to office, begging and borrowing to find a printer that's spewing out prescriptions correctly for wheelchairs, catheters, latex gloves, and the vast array of the supplies our patients need to continue their healthy lives at home.

So we welcome the opportunity to work together with these teams to find out what is going on, why the system keeps disconnecting and shutting down, whether we're doing something wrong on our end, or whether there's a design flaw inherent in the system that needs to be fixed. Because if this works, things get better. It's not that big a deal, but minutes add up, and this only contributes to the chaos and the frustration for us and for our patients when something as simple as the print function just goes nowhere.

The same can be said for so much of what we do in primary care, and in fact what all of us try to do for our patients across so much of our fractured healthcare system:

• When we decide to prescribe a medication for a patient, based on our best medical judgment, and then the patient encounters multiple hurdles, through co-pays, poor coverage, and formularies that just don't work, requiring them to jump through hoops and requiring us to spend hours on the phone trying to get authorization
• When our patients need mental health care and we can't find anyone to take care of them
• When we seek the help of the specialist, and are told the wait to get in is 6 to 9 months
• When we uncover unequal and inequitable care

Some of these things can be fixed locally, and some will need a heavier lift. Some are beyond our control, and some will need societal and political changes that we can only shout about, demand action, and keep fighting for.

All of our patients need access to all of the care they need to get as healthy as they can, to have all of their prescriptions filled whenever they need them, to not avoid getting care for fear of bankruptcy or not being able to afford food or rent. When asking about the social determinants of health uncovers hidden injustices and societal inequities that are keeping our patients from living their best lives, it's unlikely that putting in a request to the help desk is going to make it all better, but raising our voices together can hopefully get this done.

It's time to remove the paper jam. Because once we get it printed out, it's all there in black and white for everyone to see.

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