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Writing in the April 17 New England Journal of Medicine, Pamela Hartzband and Jerome Groopman throw cold water on the way the electronic medical record is being “touted as a panacea for nearly all the ills of modern medicine.” Among the touters they mention are George Bush, Michael Bloomberg, the presidential candidates, insurance companies, Google, and Microsoft. Electronic records are now in wide use, especially in leading teaching hospitals. But in actual practice, they observe, the record is sometimes simply “clinical plagiarism,” in which “physicians have clearly cut and pasted large blocks of text, or even complete notes, from other physicians.” It is now so easy to drop in a patient’s lab results in their entirety, that finding the wheat in the bushels of chaff is “like ‘Where’s Waldo?’,” according to one of the authors’ colleagues. Cutting and pasting for completeness replicates garbage and gold indifferently, making the electronic record “a powerful vehicle for perpetuating erroneous information.” “The worst kind of electronic medical record,” they write, “requires filling in boxes with little room for free text.” In a brief clinic visit, physicians may spend most of their time pointing and clicking rather than talking to the patient. I am reminded of the state automobile inspection process, at the end of which the driver is handed a printout of the dozens of details the inspector “checked” on the screen but not on the vehicle.

In the summer of 1971, KSL needed a programmer for his pioneering startup company, Computer Systems for Medicine, Inc. The company’s systems would take medical histories from patients. The system was a DEC PDP-8 computer and a teletype machine. HRL was starting graduate school and needed to earn a few bucks over the summer. He did the coding. He managed to wedge the entire program into 4K of 12-bit PDP-8 words. The working system was operationally a marvel; the branching logic was much more efficient at homing in on problems than the old fill-it-all-out paper history forms, and as Weizenbaum had discovered five years earlier with ELIZA, people would tell the computer things they did not feel comfortable telling a living, breathing human being.

That was 37 years ago. The engineers have been much more successful at increasing the storage capacity of computing devices than than society has been at figuring out how to make good use of all those bits that are now captured, reproduced blindly, and, very often, never examined critically.