John Lennon’s Elbow

The electronic medical record (EMR) has transformed the nature and purpose of hospital progress notes. While copy-and-paste has played a dominant role in this transformation, other less conspicuous elements have also contributed. These elements are characterized by George Harrison's “Long, Long, Long.” Student/resident EMR notes are long. The time required to write them is long. Most important, the time span between note initiation and note signature is long. Note time span is a new phenomenon in the EMR era. It manipulates time and transforms the traditional linear timeline of medical storytelling into a nonlinear one. In the cinematic and literary arts, time manipulation and nonlinear narratives serve to heighten dramatic impact. In EMR notes, they heighten confusion. The impact of EMR notes was presaged almost five decades ago by another Beatle, John Lennon or, more specifically, his elbow. More on that later. This essay explores long notes and long note time span in the EMR era.