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Your point about degrading gracefully is very important. Even with leading electronic record systems, paper will continue to be heavily used for producing backups, permanent copies, changelogs, etc. For example, a large regional hospital network with a state-of-the-art electronic patient record system generates a lengthy paper backup for each change made to the e-record. The system produces ~100,000 pages a month for just patient record changes. And this is considered an "all digital" system. Hmm.

What appears to be happening is a fusion of both paper and digital as a best practice. Important information is recorded digitally because it is fast and convenient, and also recorded in analogue, on paper, to leave a legal trail and backup for when the electronic systems go down (and they do go down).

(disclosure: I'm a cofounder of GetDimples.com, maker of ink-saving software and fonts.)

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