Part 1: The Note, A Relic of the Paper Era
This is the first part in a six-part series detailing the current standard in medical documentation, how we got here, and why it is long past time for a radical change. At the end of this series, we hope you are as passionate as we are about building a future that frees clinicians from endless charting and instead makes the record work for us!
Today we’re examining a cornerstone of clinical documentation, which every clinician interacts with daily, often with frustration: the clinical note. Though essential for patient care, the clinical note has become a symbol of frustration in modern medicine. For decades, clinicians have been promised that digital transformation would reduce the documentation burden and make healthcare more efficient. Yet, despite advances in technology, clinicians still spend countless hours completing And reading notes, often with diminishing returns. As electronic health records (EHRs) evolve, the clinical note—a relic from the paper era—remains central to our workflow, bringing its inefficiencies into the digital age.
“As electronic health records (EHRs) evolve, the clinical note—a relic from the paper era—remains central to our workflow, bringing its inefficiencies into the digital age.”
The Origins of the Clinical Note
The clinical note was born out of necessity. In the pre-digital era, paper records were the only way to document patient encounters. Each note was handwritten, intended to capture a snapshot of the patient's condition and the clinician's thinking at a particular point in time. The structure of the note was designed to be clear, concise, and easy to reference in the future—often by a single clinician, with little consideration for collaboration.
In this context, the note made perfect sense. It served as a self-contained record that could be placed in a patient’s file, available for future reference during subsequent visits. Paper-based notes were static, filed away, and difficult to access or update once stored. This was acceptable in a time when healthcare was less complex, and patient information wasn’t shared as widely as it is today.
The Transition to Digital
When the healthcare industry transitioned to EHRs, the clinical note was brought along virtually unchanged. The primary goal of EHR systems at the time was to digitize existing paper-based processes, not to rethink or revolutionize them. The note, in its paper-based form, was simply digitized, and with it came many of the inefficiencies inherent to paper records.
While EHRs allowed for easier storage and retrieval of information, they didn’t fundamentally change the nature of the note. Notes are still static, locked after signing, and require additional addenda or new notes to reflect updates. This outdated structure has translated poorly to the digital realm, where information should be dynamic, collaborative, and accessible in real time.
The Failures of the Note in the Digital Age
The core issue with today’s clinical note is that it is static, even in a dynamic digital world. Once written, a note is locked, becoming a permanent and unchangeable record. This rigidity leads to information redundancy and overload, as multiple notes accumulate over time, with each one adding layers of sometimes irrelevant or outdated data.
Moreover, notes in their current form are poorly suited to the way modern healthcare is practiced. Today’s clinical environments are more collaborative, with multiple clinicians contributing to patient care. Yet, the note is primarily authored by a single clinician at a specific moment in time, leaving little room for real-time updates, teamwork, or collaboration. Updates and corrections must be added through new notes or addenda, which can result in fragmented patient histories.
The note-centric model also contributes to clinician burnout. Studies show that doctors are spending an increasing amount of their workday completing EHR tasks, much of it focused on note-taking and chart review. This administrative burden reduces the time clinicians can spend with their patients and adds to the growing sense of frustration with the current state of healthcare technology.
Paper Thinking in a Digital World
The fundamental issue is that we are still thinking about documentation in terms of paper. We have digitized the paper record but haven’t moved beyond the limitations of that format. Despite all the advances in cloud computing, real-time collaboration, and data analytics, we are still working within a system that was designed for paper charts and individual authorship.
The digital era offers us the opportunity to rethink clinical documentation entirely. Digital records can be dynamic, updating in real-time as a patient’s condition evolves. They can be collaborative, allowing multiple clinicians to work together seamlessly. Information should be easily searchable, sortable, and context-driven, rather than buried in a static, linear note.
Time for a New Paradigm
The continued reliance on notes as the backbone of clinical documentation has prevented us from fully realizing the benefits of digital healthcare technology. We now have the tools and the technology to build systems that can adapt to the needs of modern clinicians and patients. These systems should allow for real-time updates, collaboration, and the ability to track a patient’s story over time, not just capture a snapshot at a single point in time.
As we move forward, it is clear that the current paradigm is not enough. The note, as it exists today, is a relic of the past. It served its purpose in the paper era but has failed to keep pace with the complexities and demands of modern medicine. If we are to truly revolutionize healthcare and provide the best possible care for our patients, we must be willing to break free from outdated practices and embrace a new future for clinical documentation.
This is the first step in our conversation about the failures of current medical documentation. In the posts to follow, we will dive deeper into the inefficiencies, the consequences for patient care, and the transformative potential of new approaches.
Let’s rethink how we document healthcare—because our patients deserve more, and so do we.
