To combat physician and resident delays in completing and signing discharge summaries and operative reports, UC-San Diego Medical Center in 1992 started using homegrown software to administer a program whereby tardy physicians were fined and suspended until they completed the paperwork.

Suspension meant they couldn't admit patients, order prescriptions or perform operations until their reports were up-to-date. The rule was that physicians had 14 days to create a discharge summary and another 14 days to sign it. They had one day to create and sign an operative report.

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