Two hours of documentation for every hour of patient care. That's the average today. It sounds like a software problem. In fact, it isn't. Doctors have needed a way to hold onto a patient's history since before paper existed, and every era has solved it differently. Some of those solutions are stranger than others.
Voodoo Doll Theory as Medical Record
A clip from a New Orleans voodoo tour has circulated widely on social media. The priest in the video claims that pinned "voodoo dolls" were never curses. They were medical charts, built by enslaved people who were legally forbidden from reading and writing. A pin in the voodoo doll marked a symptom for the next appointment. In this way, the doll became a patient file that only the healer could read.
Enslaved people were denied literacy by law. And root doctors of that era held genuine medical knowledge, passed down by mouth because writing it down wasn't an option. But historians haven't found archival evidence for the doll-as-chart claim itself. The pin-doll tradition traces to European poppets, used in English witchcraft long before anyone crossed the Atlantic.
A medical doll that was used to communicate a patient's symptoms does exist, this time on the other side of the world.
In Ming Dynasty China, modesty forbade a woman from describing her own body to a male physician. You might be wondering if there were female physicians. They weren't unheard of. But that path ran through family, not formal training open to women, so most women never had one nearby. Instead, they had to sit behind a screen and point, on a small carved figure, to exactly where it hurts. Physicians used these "Doctor's Lady" voodoo dolls into the 1950s. They're in museum collections at UCLA and the Cleveland Museum of Art today.
Different continents. Different constraints. But the same need: when you can't speak about the patient's history directly, try to memorize and document it somehow.
The History of Medical Records
Nobody can point to the exact moment medical records began. But what's clear is how much got lost along the way. Europe's early case books were destroyed by war. The Thirty Years' War and the Great Northern War destroyed huge numbers of them, along with at least half of all parish registers, the closest thing to formal health records at the time. Most 18th-century physicians simply weren't diligent record-keepers.
However, Benjamin Rush was an exception. He was Edinburgh-trained, practicing in Philadelphia in the late 1700s. Rush kept detailed patient case books that historians still point to as the template for modern medical history. Around the same time, hospitals started shifting from almshouses for the poor into actual medical institutions, and record-keeping shifted with them.
The US took its own path. New York Hospital introduced a formal Book of Admissions and Book of Discharges in 1793, the first real patient registry in the country. A few years later, physicians David Hosack and Alexander Hamilton pushed every home doctor to save their cases in writing, specifically so the knowledge could outlive the doctor and train the next generation.
[1] MDPI, Healthcare Electronic Records and Their Impact on Healthcare Delivery. View source
How exactly did the EHR begin?
Paper held for the better part of the two centuries. The next disruption came from a machine, and it started earlier than most people assume, according to a widely cited history of the EHR.
Mayo Clinic was running electronic patient records on punch cards in the 1960s. It was government-funded, because the technology was too expensive for any private practice to touch. Decades after that, digital records stayed at a hospital-system luxury. As late as 2009, fewer than 10% of US medical institutions had a large-scale computer system in place. But still, most medicine was running on paper.
Then policy did what the market hadn't: the Office of the National Coordinator for Health Information Technology was established in 2004 to push digital adoption. And the 2009 HITECH Act backed it with money, offering incentives for "meaningful use" of EHRs. It worked fast. By 2011, nearly half of US physicians were using an electronic system.
But EHRs did more than replace paper files with digital ones. EHRs changed what healthcare providers could do with patient information.
Doctors and nurses could access medical histories and test results quickly. Systems could flag potential drug interactions and allergies. And different providers could share up-to-date information. At the same time, everyday tasks such as scheduling and billing became easier to manage.
Today, EHRs are a central part of modern healthcare. They help practices work faster while supporting safer, more connected patient care. If you haven’t yet selected an EHR that brings these benefits together in one platform, then you should consider Myriad Health EHR, which offers a range of perks and features you can explore to simplify your practice and modernize workflows.
Now: How AI changed documentation
Nearly an hour a day. That's what documentation costs a provider. Every day, four weeks a year gone to paperwork. 74.4% say it gets in the way of patient care. 77.4% finish notes at home. This might be one of the biggest drivers of physician burnout, since almost half of physicians have reported at least one symptom of burnout.
Most AI scribes send the note out to an outside AI model. MyScribe AI doesn't. It stays inside Myriad's own system, so patient data never leaves. A doctor can talk through the visit, type a few quick lines, or let it listen in real time, and the tool builds the note either way. Nothing gets finalized without the doctor's sign-off first.
The results: 1 to 2 hours back a day, per provider, and a coding check before the note reaches billing, catching the errors that quietly cost or flag a practice.
The Revolution of EHR and AI Scribes
A pin in a doll once stood in for a symptom nobody could write down. A carved figure once helped a patient show a doctor where it hurt. Six centuries later, the patient's story can be captured as it happens, turned into a clinical note, and ready for the doctor to review before the visit is even over.
See what that looks like on your own charts.
