Will physicians use an EMR? Will healthcare use an EHR? Will patients use a PHR? And will these forms of digital health records be massively adopted?
Moving from a paper to a digital record brings issues of interoperability and distinguishability. In a paper world, form, presentation and content have been understood for thousands of year. Paper is paper, interoperability is a physical act: obtaining a chart, faxing a record or making a duplicate. And, paper being paper, dispenses with distinguishability as well—recognition and ability to use is mastered in childhood.
In a digital world, interoperability becomes an issue of syntax: the ability to connect, communicate and exchange information, and of semantics: where the information exchanged has meaning.
Distinguishability is an issue of how content is presented, how it is used and what is the fidelity across implementations. Part of the success of graphical user interfaces, once pass the metaphor, is the fidelity across computers and across applications. The same issue of fidelity is seen across the video game genres. The success of the iPod across several generations and the iPhone may be viewed in terms of the fidelity of the experience and the usability. The higher the fidelity of the presentation the more indistingishable the experience is across different technologies.
Interoperability is a behind-the-monitors issue, this will be driven by the coming ubiquity of digital records and the cessation in generating paper records. Distinguisability is an in-front-of-the-monitors issue. Massive adoption will not be found in the ubiquity of digitial records, but in the fidelity of the experience regardless of what is behind the monitors. Paraphrasing Clarke’s Third Law—should sufficiently advanced health records be indistinguishable?
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