Kindle is to book as Electronic Health Record is to ... what?

Dan Newman writes in todays WSJ on why he does NOT want a Kindle for Christmas, and it's worth a read. Excerpts below:
(A Kindle for Christmas? Spare me!)

I should be the perfect candidate for an e-reader: I own thousands of books, lack space for more and often schlep several heavy volumes in my bag. So when I begged my family to refrain from getting me a Kindle for Christmas, they were confounded.
[snip] 

While a search function is useful, it also points to a flaw in the Kindle: All the pages are alike, to the extent that there are pages at all. 


I remember passages by where they are in my books—this or that detail is two-thirds of the way through, on the bottom left. That physical memory runs deep.

... I've seen her set down a dozen stiff-backed Little Golden Books before a group of adults. They chatted with delight as they held old copies of ..  childhood favorites. "The physical book holds meaning," says Ms. Kroupa. "If I were to bring a modern edition of 'Dumbo,' it wouldn't elicit nearly the same response."

Print editions enable shared experiences in ways unavailable to electronic versions. I'm no snoop, but one of the first things I do when I enter a home is scan the bookshelves. As often as not, that sparks conversation about the interests of my hosts and about what they've read and hope to read. They invariably pull out other books, some inscribed, and hold them in their hands while we talk.

That experience simply can't happen crouching over a hard-drive. Imagine entering a living room and saying: "Hey! Mind if I scroll through your Kindle?"

A book is more than a shell for words: It's a box whose magic starts at its real-world dimensions. No other common item so lacks a standardized size, and that makes individual books memorable. ... Maybe I'm a Luddite because I feel sorry for children who read "Goodnight Moon" on a phone. And perhaps I'm a softie for hoarding my torn copy of "Huck Finn," a gift from my grandfather, with an inscription that still makes my eyes water.

I could tell you what it says. But it's best to read with the book held in your own hands.

Mr. Newman is a writer at work on his first novel.

I'm with Dan.   I have all my old class textbooks, heavily annotated, and know where to find a passage or equation by where it is on the page, and about where in the book that is. And the book is this big and blue and this tall and here it is and .... here's the passage I wanted to show you....  etc.

Given my focus on Electronic Health Records (EHR) , and trying to articulate what is is that's so subtle and at the same time so blatantly wrong with them,   I noted his description above.

... a flaw in the Kindle: All the pages are alike, to the extent that there are pages at all. 

It is, of course, a "given" that the pages of an EHR look alike.   In fact, the pages of every patient look alike. In fact, if designed "correctly" according to modern theory of User Interface design,  the pages will also look pretty much like your email, your word-processor, your spreadsheet, and other familiar paradigms, so it is "easy to use".

It is this "feature" which in my mind is a "bug" -- it makes the chart and the structure in it extremely easy for a computer to read and process, being as it is all "machine readable" -- but it makes it all merge into a single huge identical "chart" for a human doctor or nurse, and therefore any given patient's story becomes exquisitely forgettable.

When I pick up a book, by the time I have it open the nature of the book has brought back to mind all of the contents, that were filed,  (technically "hashed"),  based on the color, size, weight, smell, font, margins, and other distinguishing characteristics of that specific book.  This makes it easy for me to store and recall it as a single associated unit.   The question is, when a doctor opens the EHR "chart" on a patient,  is what he or she sees sufficiently distinctive that it instantly brings back to mind the contents of the patient's story?  Almost certainly not.

Does it mattter?  I think so, for the same reason that memorizing sacred writings or poetry or songs is a very different thing than looking them up.   Memorized stuff goes into a state where other things are continually compared against it, and it against them,  sometimes adding to them.    A fully-internalized patient story will go where, weeks later in the shower, something will go "click" and it will pop back into consciousness with an answer to your unspoken suspicion that there is something else going on, something wrong with the glib initial diagnosis, but you couldn't put your finger on it. That kind of error can get fixed, in other words.

The EHR stands a risk of the equivalent of being so busy taking pictures of your vacation or birthday party that you forgot to HAVE a vacation or birthday party.    Yes, you end up with pictures.  Yes, they probably are "more accurate" than your memory.  But they are not the same thing as a memory, at all.

Designers go to great lengths to put the name and 9 or ten digit patient identifier on every "screen", so that there is no confusion as to who this data pertains to.       Names, and 10 digit identifiers are not processed in the same part of the brain as, say, a photograph of the patient.

Maybe, at a minimum, a photograph of the patient should accompany every screen, so that the other part of our brain, that associates facts and builds a narrative,  is fed instead of being starved by the system.  Then when we see the patient walk in the room, we don't have to ask for their story -- it leaps to mind full-blown already.   We've associated it with something that is unique for human beings (a photo) instead of with something that all looks alike to human beings (a ten-digit ID).


RWS
Ann Arbor