This is what a handwritten history sheet (which is where we write down the most important details that we extract from a patient or responder about the case). Source
And this is what the most popular EHR/EMR User interfaces that are meant to enter the same details as the history sheet look like
See a difference?
No, I don’t mean the ridiculous amount of clutter, the confusing information architecture or just the general pathetic state of these UIs.
I mean, the history sheet is not a system of transcribing what the patient said or transcribing what data was collected. It is a notation system, a language of its own, with data arranged spatially in a particularly way, symbols used to convey information, abbreviations, and a system to indicate what is important and a method for tracking the temporal profile of the case.
The EHRs are incoherent because they are talk-transcription interfaces. Not notational interfaces.
Imagine asking an artist who is composing music, to write down, in English, the notes in each chords, the tempo and what not. Would that looks coherent? Why would you do that when you have a musical notation system?
The clinical case file, handwritten is a few hundred year old technology that’s had iterative improvements in its quality and information architecture and it works! A case note written by an doctor in Bengaluru makes perfect sense when read by a doctor in Mumbai. It makes sense when read by a different specialist. It makes sense to nurses, to pharmacists to therapists of various kinds.
It doesn’t, however make sense to the administration. EHRs serve administrative needs. Not communicative.