Most of the time when Dr. James Tcheng gets a new patient from outside of Duke Health, he starts with a bundle of paper. After his secretary receives a patient’s records—either directly from another doctor’s office or after a request is faxed—and opens them, Tcheng goes through the information, with a sheet of 8½ x 11 paper at his side for taking notes. He starts, usually, with the summary notes. Sometimes, almost all of what he reads is irrelevant. But he must go through everything nevertheless, making sure he misses nothing.