To your point about laying out electronic notes like compact paper notes, the Lifespan system of hospitals in Rhode Island is able to do exactly this. Their res

To your point about laying out electronic notes like compact paper notes, the Lifespan system of hospitals in Rhode Island is able to do exactly this. Their residency programs all use a web application that displays fishbones graphically using CSS, and other information in a compact format. I went to some lengths when developing it to abbreviate relevant medications and lab results the way the residents used to on their handwritten notes. They had developed the original format over many years to efficiently convey information, and it made sense to model the electronic version on it. Different services use their own shorthand and prefer different levels of detail on reference printouts. An entire Surgery patient census with demographics, labs, meds, and notes is designed to fit on a single page. (Even at 2-3 lines per patient, the print had to be quite small, but surgeons seem to like that.) I hear that this type of system isn't common, apparently because not many vendors go to the effort. Displaying the fields as they appear in the database also complies with the specification and serves the purpose, just not quite as well. Onscreen, the web application has fewer space constraints and also supports progressive disclosure. For example, abnormal lab results are highlighted on the printout, but their trends and normal ranges are only available by clicking or hovering over the result. Fitting everything onto a single page also becomes less of an issue because you can always jump from patient to patient via a table of contents, without shuffling paper. An iPad or high-resolution device like an iPhone 4 could marry some of the best features of paper and screen: portability, navigation, progressive disclosure, and the ability to edit.