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A study of the practices surrounding paper medical records captured key aspects of the work necessary to support this crucial element of health care. It uncovered work that was invisible to the nurses and physicians who use the records. This invisible work comprises tasks necessary to find and deliver the records as well as those necessary to ensure that the records are accurate and up to date. This study was undertaken because medical records are undergoing a transition from paper to digital systems, which will impact the practices of users of these systems at all levels, including clerical and medical staff. This is an area of particular interest to our organization as we look to provide technologies and services that enable seamless integration of paper and digital worlds. New technologies and practices will need to be developed to accomplish what is now being done invisibly.