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“If you didn’t write it down, it never happened.”

I used to hear this ad nauseam as a student doctor.

Heads of departments regularly gave statistics on how many cases were pending litigation due to clinicians’ notoriously poor handwriting.

No doubt, I thought their scare tactics were silly until I personally was dragged into a medico-legal case as a junior resident. It was note-taking that saved my rear. This stuck with me.

A quick audit of the wards I worked in showed clinical notes missing dates and time stamps, the use of non-approved medical shorthand, missing signatures, and designations. The problem was evident. Repetitive manual inputs were causing clerical errors. Clerical errors were leading to clinical errors.

Currently, public EHR systems in South Africa are wildly inefficient.

How inefficient, you ask? It depends on where in the country you reside. Try arriving at work over an hour earlier, just to ensure enough time to document progress reports. Or requesting a patient file, only to find it has gone missing due to an archaic filing system. Or printing CDs of patient CT scans when they need to be discussed externally. Yes, CDs! (You’re excused if you don’t know what these are.)

I always have been curious about understanding why some of these practices still exist, especially after the promising pilot of the DHIS2 platform launched a few years ago. A question I hope to answer in due course.

As newer electronic health record systems technologies come to the fore, they will create much-needed insight into fields such as epidemiology and precision medicine to name but a few.

In future I will adress the oddity that is the medical record within the African context. The medical record lifecycle, how this old tech from the ’60s can be sort out to create new and exciting data models, and what Africa should be doing to champion its digitization.

I'll dive into some of the reasons why the pen isn’t mightier than the sword, explore medical record-keeping best practices, address issues of cost, scale, security, service providers and infrastructure, revolutionary technologies, and the careers that keep these various record systems afloat.

Stay blessed!

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