A post in Colin Jervis' Future Health IT blog entitled Smartpen: rewriting the record reminded me of insights I gleaned from John Seely Brown and Paul Duguid's book The Social Life of Information, which I read just before starting the Master of Science in Information degree program I am pursuing. The new Smartpen technology is yet another way to keep paper alive as an information medium, an outcome I heartily endorse and desire - and not because I'm a Luddite, not by any means.
Paper is cheap, flexible, readable in nearly any light conditions, consumes no power as it stores information, and adaptable to storage of all kinds of information. But what's most important about paper is that information stored there stays put, as a general rule, and modifications are relatively easy to detect.
Jervis writes:
Smartpen allows pen and paper to be integrated with IT. You write with ink in the normal way and a tiny camera records the pen's strokes which you download onto a PC. You then have a hard copy and a digital copy that can be integrated into an Electronic Patient Record accompanied by a full audit trail.
The best of both worlds, in my opinion. I have some reservations about manual transcription of things like heart rate and BP - I'd rather see machines tell other machines about data they've captured, and leave human transcription and OCR errors out of the picture. Much of what gets written on the chart, though, is normative and highly contextual, and for that, paper is the perfect medium.
In an interview they did with HBS Working Knowledge back in march of 2000, Brown and Duguid said:
Books and paper documents set a useful precedent not only for document design, but also for information technology design in general. In a time of superabundant raw information, they suggest that the better path in creating social documents (and social communities) lies not in the direction of increasing amounts of information and increasingly full representation, but rather in leaving increasing amounts un- or underrepresented. Efficient communication relies not on how much can be said, but on how much can be left unsaid — and even unread — in the background. And a certain amount of fixity contributes a great deal to this sort of efficiency. This is not to minimize the significance of the new fluid technologies. But social and institutional pressures that favor fixity will also have a say in the outcome of current transformations.
There is a demographic qualifier to these "social and institutional pressures". Paper has a generational advantage, at least for another decade or two: everyone who must document healthcare is familiar with and skilled in the use of paper as an information medium. When healthcare practitioners born before 1965 or so retire from the workforce, this advantage will be much less than it is now, and of course by then as-yet-unimaginable changes will have taken place in the realm of information technology. Our grandchildren will live in a post-paper world, in all likelihood, ending a multi-millennial era in which paper was nearly synonymous with information itself.
Meanwhile, devices like the Smartpen will ease the pain of the transition.
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