Established in 1980 by Dr. Eric Robinson in memory of his wife, the prize is awarded annually for the best-delivered paper by an individual who is making his, her or their first appearance at the Society’s annual meeting. Candidates for the award are judged not only on the quality of the historical research and scholarship of their paper, but also on the effectiveness of the oral presentation.
Roan Parrish, Virginia Tech
For: “Constructing an Electronic Medical Record.”
The Robinson Prize Committee is pleased to award the 2023 Joan Cahalin Robinson Prize to Roan Parrish for her presentation “Constructing an Electronic Medical Record.” Parrish, a Ph.D. candidate at Virginia Tech, delivered an original and engaging presentation on the introduction of electronic medical records in American hospitals, examining the impact of computer science on the practice of medicine.
Parrish focused on the establishment of the Laboratory of Computer Science (LCS) at the Massachusetts General Hospital in 1964, which aimed at developing a computer-automated system tailored to the needs of the hospital. Parrish showed that the efforts of the Cambridge company Bolt Beranek and Newman (BBN) to create a computerized hospital ran into some major problems: the early system was not at all practical for regular hospital functions. BBN therefore worked on a new programming language, scalable in nature, that could implement operational information systems for compartmentalized hospital tasks. A major challenge for the developers was to create a computerized medical record system, particularly one that would allow reuse of individual modules across sites, and recognize multiple terms for the same condition or medication.
The electronic record system created at LCS enjoyed some success as it was adopted by other hospitals in the United States and abroad. However, the system also met with much resistance, especially from physicians who were accustomed to working with handwritten records. In this regard, Parrish showed that the acceptance or resistance to the use of the electronic system lay not only in the intrinsic potential of the technology, but also in a certain inertia of existing practices. This led to hybrid forms of record keeping, based in part on computer models but completed by hand, which then became difficult to catalog and risked dispersing or losing knowledge about patients and therapies. Parrish also considered the question of creating the expertise to manipulate electronic records and the training of hospital staff. This raised questions not only about the division of labor in the hospital, but also about gender, since the people who had to work more directly with electronic records were nurses and other staff, mostly women.
Parrish’s argument was supported by solid evidence that required careful work in medical archives and a clear understanding of the history of computing. The narrative she produced was rich and multifaceted, pointing to the non-linear relationship between technology and healthcare practices. In conversations with the audience, Parrish provided extremely clear answers and demonstrated a complete mastery of her research subject, clearing up any lingering doubts in the audience.
The judges were impressed by Parrish’s skillful presentation of her research, which stands as an original contribution to studies of the relationships between medicine and computer science, and as a timely reflection on what computers can and cannot do. For these reasons, Parrish’s presentation seems most deserving of the 2023 Robinson Prize.