How existing clinical culture demonstrates a variety of attitudes regarding the role that IT can and should play in patient care.Strategic Action In Health Information Technology: Why The Obvious Has Taken So Long Today the United States is poised to achieve what has been sought and anticipated for at least three decades.
by Edward H. Shortliffe
ABSTRACT: Recent enthusiasm for the automation of medical records and the creation of a health information infrastructure must be viewed in the context of a four-decade history of anticipation and investment. To understand the current opportunities and challenges, we must understand both the evolution of attitudes and accomplishments in health care infor- mation technology (IT) and the cultural, economic, and structural phenomena that con- strain our ability to embrace the technology. Because prudent IT investment could make a profound difference in U.S. health and disease management, our strategic response must begin with an understanding of the pertinent history plus the challenges that lie ahead.
M o r e t h a n f o rt y y e a r s h av e pa s s e d since the first use of com- puter systems to support patient care through the management of clini- cal information. Among the early experiments, the Lockheed/Technicon
system at El Camino Hospital in Mt. View, California, is perhaps the best known and most influential of the “hospital information systems.”1 But the idea rapidly gathered momentum, and by the late 1960s there were experiments with full- fledged electronic medical record (EMR) systems that collected data directly from clinicians and were designed for use in both inpatient and outpatient settings.2 Ar- chaic by modern standards, these systems predated personal computers, local area networking, and the World Wide Web. Yet many embraced a vision of health and health care supported by EMRs, even though some observers expressed concern about the influence the technology would have on clinical practice and the train- ing of practitioners.3
During the subsequent three and half decades, society has been inalterably changed by the growth of computing and electronic communications, with mod- ern cell phones having more computing power than machines that supported
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DOI 10.1377/hlthaff.24.5.1222 ©2005 Project HOPE–The People-to-People Health Foundation, Inc.
Ted Shortliffe (shortliffe@dbmi.columbia.edu) is professor and chair of the Department of Biomedical Informatics, College of Physicians and Surgeons, at Columbia University in New York City.
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multiple time-shared users in 1970. Those who have worked in health care com- puting during this period of remarkable change often express frustration regard- ing the slow rate of adoption of information technology (IT) in health care when compared with other societal components (including finance, electronic com- merce, travel planning, general news and information dissemination, and educa- tional support, to name just a few examples).