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I will divide Paper Medical Records’ (P-MR) affordances into data entry affordances and data retrieval affordances. I do realize that the divide between these two groups of affordances is not as neatly separated when compared to current computer systems. With paper, you could be reading and jotting notes at the margins at the same time. While with most of current computer systems, you cannot just add notes on the margin of forms and documents. In these computer systems data entry and data retrieval processes are separated. In this post, I will only address data retrieval affordances.

Having took the time to write posts on medical records goals and on affordance,  I will re-write a post on the divide between affordances and goals. In my previous post, I used the term purpose instead of goals. In this post I will stick with goals.

The focus of this post is the study conducted by Nygren and Henriksson (1992). It is the only study I passed by that truly tries to understand what actually takes place when physicians are using medical records. This study only focused on paper medical records. Conducting a similar study to understand how physicians use electronic medical records (EMR) would be much more challenging due to EMRs diversity.

This study illustrates neatly the more elusive goal of using medical records which is as an intellectual tool. P-MR is a tool that supports physicians’ cognitive processes including decision making.

Yet, I differ with the authors in using the term ‘goals’ in describing their main findings. They found that physicians used P-MR to: (link to a summary of the study)

· Gain overview

· Trigger memory

· Search for facts

· Problem solve

I still stand by my opinion that physicians use medical records for the two goals I mentioned in my previous post: communication and intellectual tool to support cognitive processes.

These four points are more off affordances than goals. Yes, authors did mention three other affordances of P-MR:

· Reading

· Skimming

· Skipping

But, I believe all of these seven should be called affordances. To reap the first four affordances you need to perform the latter three. Gaver (1991) call affordances that can only be appreciated after performing the action with proceeding affordances sequential affordances.

The purpose of Nygren and Henriksson (1992) study was to find how physicians use P-MR to match these to develop better computer interfaces. However, matching affordances should not be our goal. Matching the ultimate goal of P-MR is a more worthy goal. Computers may offer better affordances that if utilized will reach the goals of P-MR without the need to match paper affordances. Yet, Nygren and Hendrickson enrich our knowledge on the application of affordances in a more critical way. If you recall the definition of affordance:

an action possibility available in the environment to an individual

-McGrenere and Ho, 2000

Affordances relate to individuals. For example, when designing stairs the height of steps must allow humans to easily use them. Too high steps will make climbing hard if not impossible. Affordances of EMR should address how can humans use them. Nygren and Henriksson study does just that. It allows us to understand how physicians think. This knowledge is needed to design tools that will be used by our brains. This knowledge is needed to design EMR affordances.

In following posts I will try to understand how humans of read, skim and skip. This knowledge will be necessary to design EMR affordances.

Gaver, William W. (1991): Technology Affordances. In: Robertson, Scott P., Olson, Gary M. and Olson, Judith S. (eds.) Proceedings of the ACM CHI 91 Human Factors in Computing Systems Conference April 28 – June 5, 1991, New Orleans, Louisiana. pp. 79-84.