Physicians encountering a new technology such as electronic health records (EHRs) typically use it to solve the same problems they were trying to address with older technologies. It takes time to determine that the new technology creates entirely new possibilities for practice. For instance, when the electrocardiogram was first invented, it was thought to be a better version of an older technology, the Mackenzie polygraph.1 The Mackenzie instrument, which made a simultaneous visible record of mechanical events (radial pulse, jugular venous pulse) in the cardiac cycle, was a powerful tool in unlocking the problem of cardiac arrhythmia. Initially, the electrocardiogram was considered simply a “better polygraph” and was used only to understand arrhythmias. Because the T wave and ST segment do not have mechanical equivalents, early electrocardiographers ignored them, overlooking tracing changes now considered classic for acute myocardial infarction. Similarly—but perhaps not surprisingly—physicians today often consider the EHR to be simply a better version of the paper chart.
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