The other day, I was sitting in O’Hare International when I learned my plane was delayed. To take my mind off the prospect of arriving later than I’d planned, I watched the mechanics that were crawling over the plane outside the window.

I wondered, has the plane been burning oil? If a warning light is not working, when was the last time it failed? How recently were the hydraulics checked? Since the American Super 80’s that I was looking at are older than many of the passengers who were waiting to board, I suspected there was a rich history on this particular airplane.

Do you suppose that in the front of the plane somewhere, there is a file folder with this wealth of maintenance information enshrined within? If there is, what are the odds that all the mechanics who worked on the plane in all of the airports it visits looked through the paperwork and updated it properly, with every notation in the right location for the next mechanic to read?

And I’m about to get on this plane? If that were the way the maintenance records worked, would I be the only one nervous about getting on the plane?

And what about trends, I wondered. Has this particular warning light been going out a lot across lots of different Super 80’s? Has some mechanic figured out how to fix it?

If all of the mechanic’s data really was in a file folder – there’s no practical way to look for trends. Common malfunctions would be an opportunity for every mechanic to make a brand new discovery. How exciting! (Unless of course you’re a passenger).

Fortunately, there’s an entire industry of aviation maintenance software.  They may not call it an EPR (Electronic Plane Record) but the software lets mechanics assess the history of individual planes and document the maintenance they perform. Hopefully, it also lets mechanics data mine to look for trends – are all of the planes from this model number suffering from the same warning light problem? What should they do the next time the plane goes in for a tune-up? What’s about to wear out, based on hours flown and similar planes’ histories?

I’ll close with this thought: Isn’t it curious that we would never tolerate a paper-based airline? Not only maintenance but the entire process – how badly do you want to return to the days of phone-based airline reservations? The fact is, we wouldn’t fly a paper-based airline today, no matter how cheap.

The analogy to Electronic Health Records may be obvious but it’s worth stating out loud. Amid the recent buzz about a Health Affairs study that found EHRs did not reduce imaging costs (read Steve Shaha’s response to the study here), it’s worth reminding everyone that even the authors of the study are sold on EHRs.  In fact, lead author Dr. Danny McCormick told Steve Lohr of the New York Times that he “would never go back” to paper charts in his own practice.  

I assume Dr. McCormick likes his medical care as safe as the friendly skies.



About the author

Stanley Crane is Chief Innovation Officer for Allscripts. In his more than 30 years of healthcare and consumer-related software experience, he has led the development of award-winning software programs including electronic health record, electronic prescribing, web-based medication sales, online physician education, resource scheduling, financial systems, materials management, medical translation software and voice recognition dictation systems. Previous to his healthcare experience, Stanley was involved in Silicon Valley, where he held positions with many well-known software companies. As the General Manager of Lotus cc:Mail, he created the first remote mail products. He was also the Vice President of Engineering at WordStar International, and Director of Applications at Ashton-Tate, managing their Macintosh products as well as dBase IV. Before that, Stanley was a founder of two Internet startups – MaxMiles, an automated frequent flier mileage aggregator, for whom he built the first versions of the product; and Shopping@Home, a company that was acquired by Allscripts in 1999 to support medication sales.

2 COMMENTS on Would you fly if jet mechanics used paper charts?


King says:

03/18/2012 at 9:45 pm

Wouldn’t this be oversimplifying a bit?

I would think that the analogy doesn’t exactly hold because planes themselves are not people. People get weirded out about their own information. We put some much emphasis on the freedom of choice and privacy that we let inefficiencies into the system, but the solution can’t just be to get rid of the freedom just to make the system more effective.

Second of all, much of this has to do with the healthcare system as a whole. In other places where there is socialized medicine, the effects of EHR systems can be seen directly by the people paying for it. Here, it is a mishmash of different insurance payers and government incentives. In other settings, you can sell the idea of EHRs by promising lower costs. This doesn’t work here because the patients aren’t the payers of the system. So, while we can’t offer any cost reduction, we can offer convenience. It is only recently that convenience has become a selling point for patients. I think the EHR that wins will have the easiest, simplest interface.

I do believe it is high time that we get EHR systems for everyone so that patients can utilize their advantages. It just seems wrong when the easiest way to do that is to strongarm everyone into giving up their privacy rights.

Stanley Crane says:

03/26/2012 at 2:43 pm

King – Thanks for your comment. I am 100% in agreement that people’s privacy rights are of paramount importance, but as you said, privacy is not the only factor.

For a while now, I’ve been wondering about the disparity in information availability in every aspect of our lives versus the information availability in healthcare. I think we would all agree our financial records are private – and when we decide we’ll let someone in (so we can buy a car or a house), we can share that trusted, complete snapshot of our financial information with the lending institution.

Even in airplanes, there is information available when you need it. Yet in healthcare, the information tends to be on paper and tends not to be easily made available when you need it. Why is there no credit report of healthcare?

EHR’s partially reduce the cost of healthcare because they reduce the amount of duplication. My classic example is “When was your last tetanus shot?.” Most people don’t know – and that lack of information will carry the cost of another tetanus shot – whether you need one or not.

But IMHO the real savings with EHRs will come from saving TIME. And it will do that by linking all of the EHRs together so that no matter how many times you move, your data follows you around, really not unlike your credit report. So that your current doc could look back through your old records and look for trends and patterns.

I was very surprised to learn how frequently in health the lab VALUE is not the important part; it is the TREND that is the important part. That is, how does the current value compare with the past values?

Imagine you just moved from one state to another. Your new doctor sees a borderline troublesome lab value – and he tells you to exercise more, eat better (whatever), and come back in 6 months and he’ll repeat the test. What’s happening is two things: 1. Will some different lifestyle choices make a difference? 2. What’s the trend? Is it getting better or worse? Was that just an anomaly?

In my mind the real issue is the 6 months – what if your previous physician had done the same test before you moved? Armed with that previous knowledge, couldn’t the new doctor make a better plan of care right then? You had to wait 6 months to make a decision, when you and your physician could have made presumably that same decision sooner.

We’ve all had it drilled into us about the importance of early detection of cancer – why not the early detection of everything?

We do that with something like the credit report of healthcare – both protecting the information, but using that information when it’s needed to deliver the best health outcome.


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