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The Computer-Stored Medical Record-Reply FREE

Ralph A. Korpman, MD; Thomas L. Lincoln, MD
JAMA. 1989;261(18):2637-2637. doi:10.1001/jama.1989.03420180060023
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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

REFERENCES

Lincoln TL, Korpman RA.  Computers, health care, and medical information science . Science . 1980;;210:257-263.
Wiener N. The Human Use of Human Beings . Boston, Mass: Houghton Mifflin Co; 1950;.
HayesRH,Jaikumar R.  Manufacturing's crisis: new technologies, obsolete organizations . Harvard Business Rev. (September) -October 1988;:77-85.
Mowry MM, Korpman RA. Managing Health Care Costs, Quality, and Technology . Rockville, Md: Aspen Systems Corp; 1986;.
Meeks BN.  X.400 grows up . Byte . (December) 1988;:149-152.
Morison E. From Know-how to Nowhere: A History of American Technology in the Nineteenth Century . Mineola, NY: Dover Publications Inc; 1974;.

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Lincoln TL, Korpman RA.  Computers, health care, and medical information science . Science . 1980;;210:257-263.
Wiener N. The Human Use of Human Beings . Boston, Mass: Houghton Mifflin Co; 1950;.
HayesRH,Jaikumar R.  Manufacturing's crisis: new technologies, obsolete organizations . Harvard Business Rev. (September) -October 1988;:77-85.
Mowry MM, Korpman RA. Managing Health Care Costs, Quality, and Technology . Rockville, Md: Aspen Systems Corp; 1986;.
Meeks BN.  X.400 grows up . Byte . (December) 1988;:149-152.
Morison E. From Know-how to Nowhere: A History of American Technology in the Nineteenth Century . Mineola, NY: Dover Publications Inc; 1974;.
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To understand the clinical management of acute heart failure syndromes.
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