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Ann Thorac Surg 2000;69:1821-1822
© 2000 The Society of Thoracic Surgeons
a Division of Cardiology, Emory University School of Medicine, 1639 Pierce Dr, WMB 319, Atlanta, GA 30322, USA
e-mail: bill{at}ecor.eushc.org
Who would have predicted the world that is currently developing around us? The world of medicine, included, is in the process of undergoing a profound change in the way information is handled that will affect medical education and health care delivery in dramatic ways. We can get a glimpse of the changes that are coming in the paper by Ratcliffe and associates, which is presented in the current issue of The Annals. The authors have developed and tested an internet-based system for collecting postoperative data after coronary artery bypass surgery. The application permits data collection, note generation, and variation in practice pattern from clinical pathways. Unlike most current data collection applications in hospitals, this application is written in Java and is internet based, potentially making it available to multiple computers on a hospital network or beyond, thereby eliminating the need for a client program on multiple PCs. The application also joins the areas of data collection, note generation, and quality of care assessment. Other activities, such as education, could also be added.
Computers have come late to medicine compared with other industries. Their initial use, as with many other areas, was for financial purposes. This is not surprising, as financial activities can be centralized and are repetitive, and, thus, given to computerization 30 or more years ago in the early mainframe computer era. However, computers have long since moved beyond financial transactions to managing day-to-day activities. The most ready comparison is the airline industry. It is hard to imagine travel without computer technology. The diffusion of the internet into everyday life integrated readily with the airline industry, such that it is now a trivial affair to arrange reservations over the internet, with certainty that the transactions will be successfully accomplished.
Medicine has varied from other areas of society for a variety of reasons. Medical information is clearly quite complicated and not always easily reduced to fields and forms suitable for electronic information. Furthermore, information systems in hospitals have also been undercapitalized as a result of financial pressure and incentives that have not rewarded information system development outside of the financial area in medical centers. Consequently, medicine has been left behind with paper charts and constant difficulty in accessing information.
However, the world of medicine is changing, and it will be barely recognizable as these changes unfold. The reasons are certainly manifold, but perhaps paramount is the demand for greater accountability and realignment of financial incentives, as well as a demand for greater emphasis on quality of care and evidence-based medicine. Second, the explosion of information has made anything other than electronic management unreasonable. Finally, technological advances, especially the development of the internet, have made electronic systems both financially more realistic and operationally more reasonable. Thus, over the next several years, we can expect to see clinical information in medical centers becoming all electronic and readily available. Clinical care and information gathering will go hand in hand, while practice variation will be monitored in real time. Information from guidelines, clinical trials, clinical databases, pharmaceuticals, and perhaps much more will be readily available. Education will focus less on memorization and more on reasoning and accessing information and organizing it.
The difficulties that lie ahead should also not be underestimated because there is not agreement on what the new electronic world of medicine should contain and how it should be organized. The information available in the areas noted above are not necessarily organized in ways best amenable to making it all available on computers. Computer infrastructures will need to expand. Finally, the information systems of the future will need to be developed with full sensitivity to concerns over patient confidentiality. The challenges ahead are great, but the prospect of providing improved, more efficient, and even more humane medical care beckons.
Related Article
Ann. Thorac. Surg. 2000 69: 1817-1821.
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