It's Not a Pulp Fiction: Never Underestimate the Power of Paper

This year I had a several chances to visit medical/dental clinics for check-ups.

My home doctor and dentist are using fully electronic medical/dental record systems (EMR/EDR), so my records are kept electronically and virtually nothing on paper. Even an X-ray image has been sent online. As a result, I don't have to carry a large brown envelope containing my records with a referral letter.

No wonder New Zealand ranks among top countries for primary care electronic health record adaptation. Then, are they paperless systems? No, I have whole lots of pieces of paper they printed out. Mainly bills and receipts and appointments. Maybe they could be substituted by email notifications. But I can bet I would be printing them out instead.

Once I really tried hard to get along without any paper at my work as health IT analyst. I felt obliged to do so as I was advocating "paperless" systems. But I had to throw away that practice eventually. It was just not practical. So I would never recommend it to health practitioners especially if they are to take care of me!

The power of paper should never be underestimated. It is said that we are using more paper than ever as IT adaptation become dominant. It quite matches my own observation. Actually the more IT advances the more useful and attractive its paper output becomes. So it gets just more and more irresistible.

Frankly speaking, in healthcare settings, physical cost of paper (and ink) is negligible compared with other significant resources. If a pack of paper can make difference in a life-and-death situation who cares its cost? What actually matter and should be reduced are the operational costs and potential errors in handling paper, not paper itself.

So I would like to propose a more accurate phrase to represent our practical goal: Paperwork-less EMR systems.

It All Began with a Request from Arthur

His name was Arthur. He was my guru. He was the one who lead me to this path. I made my debut to the world of health IT standardisation as his potential successor.

His request to me was quite simple:

Look for the standard CONTENTS for comprehensive electronic medical record system (EMR), not for standard FUNCTIONALITY of EMR.

For over a decade, I have managed to survive and become a someone out of a novice at that time. The word for that kind of systems has changed over the time, EMR to EHR (Electronic Health Record) and then to PHR (Personal Health Record). It was lucky for me to be given the right initial direction. Because of it I have not gone off the course so much.

After all, functionality is about what the health provider as a user should do for the system to do his/her job. On the other hand, contents are about what the system has to offer to help to get his/her job done.

Without contents, the user with professional knowledge should administer every single command for the system in every detail. With common best practices as contents, the system can navigate the user through the complicated functionality according to his/her initiative.

Functionality attracts the user at the first look, but the beauty is found within contents. But how can we create such contents? We have to explore further to discover the answers.

Quest for the Holy Grail of Health Informatics

I dedicate this particular post to my best mate, Lindsay.

If you are young enough, one morning after some decades, you may wake up to find a news headline like this:

The First Computer Scientist to Win the Novel Prize in Medicine:

--- for contributing to a grand breakthrough in medicine by designing the huge information anomaly detector dubbed as "Super-Kamiokande of Medical Science" which was essential for the discovery ---

Sounds like a cheap science fiction? Or a daydreamer's fantasy?

But there is one thing which some experts think might be able to make it happen.

Universal Semantic Interoperability - some call it Unified Field Theory of Health Informatics - which enables:

• Whom - any humans from any backgrounds and any machines from any makes
• What - to communicate and understand the healthcare information between each other
• How - in full extent and depth, over ages and beyond generations to come.

Here begins the saga, the quest for this Holy Grail of Health Informatics.

Hopefully it is not a fiction, but a real-time documentary.