If EHRs Were Libraries, You’d Walk Out Frustrated

Imagine walking into a library that isn’t organized by subject or genre — but by media type.

Books on one side, magazines on another, DVDs over there. Within each section, everything is sorted by date and author.

You’re looking for a book on small business.

You don’t know the title, but you know what you want to learn.

You walk to the “Books” section — thousands of titles arranged by publication date.

Then to the “Magazines” section — same problem.

You check the “DVDs” corner, just in case there’s a documentary.

After 20 minutes of searching, you walk out frustrated, empty-handed, and slightly incredulous.

No one would design a library like that.

But that’s exactly how we designed the electronic health record.

The EHR: Organized by Format, Not by Meaning

Open almost any EHR, and you’ll find a collection of tabs:

• Notes

• Labs

• Imaging

• Meds

• Problem list

• Summary

Each represents a media type. Each is timestamped.

None tells you the story of the patient.

You can find a lab result, but not how it fits into the patient’s diabetes.

You can read a note, but not whether it changed the plan for hypertension.

You can view an image report, but not how it connects to the chest pain the patient came in for.

Every EHR is a library sorted by format and time, not by topic or meaning. And that makes finding context painfully hard.

Why It’s So Exhausting

Clinicians don’t think in data types. We think in problems.

A patient doesn’t have “one lab, one note, one medication.” They have diabetes, hypertension, asthma — and all the related evidence that connects to those problems.

Yet the EHR asks us to navigate the chart as if we were cataloging clerks, not clinicians.

To reconstruct a story that the system itself broke apart.

That’s why chart review is slow.

That’s why burnout grows.

That’s why even excellent documentation can feel unusable.

The structure of the system forces us to think in the wrong direction.

Libraries Solved This Centuries Ago

Libraries faced this problem long ago. Early collections were organized by format and chronology. But as knowledge expanded, librarians recognized that humans don’t search by date or medium — we search by topic.

So they created systems like the Dewey Decimal and Library of Congress classifications — schemas that reflect meaning, not media.

A medical chart needs the same evolution. It’s not enough to have data stored. It must be stored with purpose, so related information is connected by concept — not just timestamp.

Why Search Isn’t Enough

Some argue that we can sidestep all this by just asking an AI to find what we need.

That’s like giving every library patron a personal librarian who runs laps through a chaotic warehouse every time you ask for a book.

It’s helpful, sure — but it’s also inefficient, fragile, and dependent on the librarian’s memory.

You shouldn’t need divine intervention to find the last A1C or the reason a medication was stopped.

The right fix is simpler: structure the shelves properly in the first place.

Organizing by Problem

Imagine opening a patient chart and seeing “shelves” for each clinical problem — diabetes, hypertension, gout, depression — with every relevant lab, medication, and note attached to its rightful place.

You could instantly see what’s new, what’s stable, and what’s unresolved.

You could follow the patient’s story, not the EHR’s data model.

You could walk into the room already informed, not overwhelmed.

That’s not futuristic. It’s just a better library.

The Cost of Staying the Same

When information isn’t organized by meaning, everything downstream gets harder:

• Chart review becomes detective work.

• Quality measures miss nuance.

• Coding accuracy suffers.

• Collaboration requires translation.

And the burden shifts to the clinician — the human middleware who spends hours reassembling what the system has scattered.

This is why speed alone won’t save us. If the library stays broken, the faster printing press just floods it faster.

A Better Way Forward

The future of documentation isn’t search, and it isn’t speed — it’s structure.

When we organize medical information around problems — the way clinicians actually think — we stop treating the chart like an archive and start treating it like a map.

The difference between chaos and clarity isn’t how much data we have.

It’s how we organize it.

Next in the series: The Hidden Cause of Burnout: Reviewing, Not Writing.