Response to “Paper Kills”

I was reading a lengthy Q&A with Newt Gingrich in Freakonomics this morning, and came across the following:

Q: You discuss a united American front in your book. What healthcare platforms do you think Americans will unite around?

A: “… This system will have three characteristics, none of which are present in today’s system…. It will make use of information technology. Paper kills. It’s just that simple. With as many as 98,000 Americans dying as a result of medical errors in hospitals every year, ridding the system of paper-based records and quickly adopting health information technology would save lives and save money. We must also move toward e-prescribing to drastically reduce prescription errors.

Newt Gingrich is a powerful man. I am glad he is comfortable with and encouraging of technology. Me too! However, I am terrified of the assumption that information technology systems are inherently better or less error prone than paper systems. “Paper kills” is a nice, tight tag line that people are bound to remember. Is it true?

My earlier post on Paper Protocols saving lives and dollars in Michigan says otherwise. So does research in the context of medical adherence. Linda Liu and Denise Park (2004) identified a paper system as one of the most effective tested when it comes to diabetics remembering to measure their glucose.

It is not the material of the system, it is the design of the system that makes it either intuitive, fail-safe, or error prone. Blindly replacing known paper protocols and records with electronic alternatives is not a guaranteed improvement. This is the kind of thinking that brought us the touchscreen voting system.*

“Oh, it wouldn’t be blind,” one might say. I hope so, but a blanket statement such as “paper kills” doesn’t give me confidence. Paper doesn’t kill, bad design does.

I wouldn’t want to end this post without being clear: We need to stop pitting paper against computers and start solving:

1. Under what circumstances each is better

2. Why each would be better

3. How to best design for each. Paper isn’t going away, folks.


*The linked article mentions reliability and security without mentioning usability. I don’t want to go too far afield, so I will save my post on being unable to vote on the Georgia Flag (thanks to the compression artifacts present in the pictures, making it impossible to tell them apart.)


Liu, L. L., & Park, D. C. (2004). Aging and Medical Adherence: The Use of Automatic Processes to Achieve Effortful Things. Psychology and Aging, 19(2), 318-325.


2 thoughts on “Response to “Paper Kills””

  1. The assumption that the introduction of “technology” will magically solve many problems forgets the fact that people have to first be trained to use the technology. Have you ever seen the medical documentation software that health professionals use? The one I saw was usability nightmare.

    I had the opportunity to follow several nurses around a hospital that had a pretty sophisticated electronic documentation system. One of the most striking things I observed was that paper records were being transcribed into the electronic system AND electronic documentation was being transcribed into paper! Each time that is done is a potential error opportunity.

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