The Computer-Stored Medical Record-Reply

In Reply. —  In their letter, the writers make multiple assertions ad hominem, but only limited space is available for a short rebuttal.We editorialized that the computer-stored medical record should serve the patient first and that technical design should be subservient to that goal. The task is difficult. Elsewhere¹ we note that "problems... arise when one attempts to integrate the rich knowledge-base and behavioral variety of health care with the logical constraints of computer-oriented information processing." Everyone has experienced computerized procedures that are dictatorial or infuriatingly awkward—mocking Wiener's ideal (and warning) that computers should promote "the human use of human beings."A timely article³ subtitled "New Technologies, Obsolete Organizations" recently reviewed the relative merits of a consistent overall design vs incremental improvement via networked islands of automation, citing Federal Express as a system that needs all of its parts to offer a significant new service. These authors