Clement J. McDonald, MD, Discussant: Technologic replacements for existing human processes always tend to disappoint in their early stages because they do not include subtle but important features of the processes they try to replace. The paper charts that were replaced by one of the earliest medical record systems mixed the handwritten notes of all clinical professionals in one time sequence (47). Notes of physician, social worker, nurses, and pharmacist were intermixed. In the paper version, a user could easily find and follow the thread of one author's, or kind of author's, notes without reading all of the text because the handwriting style, note organization, and ink color provided the visual cues needed to follow the thread. In the computer version of this system, all of these navigational cues were lost, because the text was generated by the computer through a user's menu selection and the differences in note structure, handwriting, and ink color disappeared. Progress, maybe, but also a new inefficiency for providers and an opportunity for error. Today, this problem does not occur because the computerized medical records do usually label and sort notes by the name and type of author.