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of airplane tickets and visited everyone I could. Early ad- vertisers included Medicus, SMS, Compucare, Technicon, HBO, McDonnell Douglas, AMI/PHS, Tymshare Medical Systems, DATX, NDC (DataStat), The Kennedy Group, Amherst Decision Support Systems, Space Age Computer Systems, Nadacom Health Information Systems, EDS, Medlab, Dilts & Kappeler, Élan, Dynamic Control, and NCR. By the end of the fi rst year, we had changed the title to Computers in Healthcare to expand our reach beyond hospital walls, and our number of advertisers had doubled.

Cover stories included information systems execu- tives from hospitals and clinics around the world, as well as many of the entrepreneurs who built vendor-created systems.

So what two cents can I add about the progress of com- puter and information-related technologies in healthcare in the last 30 years? 1. Slow progress. Thirty years in the life of the magazine and some 40-plus years as an ob- server of our business make me wonder why we are not any further along than we are. 2. Defi ning the “right way.” I do know that the processes of patient care, the practice of medicine, management and re- imbursement with information systems are tough tasks at best. I can personally count hundreds who have lost their jobs trying to get it all done the right way. Add to this list that there continues to be debate on what is “the right way.” 3. Agreement on clinical systems best

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practice. I also know that it is diffi cult to get a consistent answer for “What is right with a clinical information system?” from those profes- sional clinicians who have been taught all their lives to get to the bottom of “What is wrong?” Physicians, are you listening? 4. Inconsistent system development approaches. For a long, long time many vendors approached clinical or medical information systems design and development the wrong way. Some were bent on protecting their fi nancial systems investments, some were protecting their stand- alone departmental systems and some were protecting both. Unfortunately, many clinical vendors have looked through the eyes of disciplines other than medicine and patient care. I am also not sure about the long-term impact of all the mergers and acquisitions that have made a few rich but have left many with less than the best in direction, functionality and integration. 5. Ever-increasing rate of change. The fi eld of medi- cine has been advancing at an incredible rate over the last 100 years, and as we approached the Medicare/Medicaid funding years, it accelerated even faster. My “guesstimate”

is that the knowledge base or fi eld is doubling faster than anyone can keep up with. These information systems cost a lot of money and time to design, build and implement correctly – and you’re not done even then. Most CIOs estimate that ongoing optimization, process improve- ment and maintenance will add an FTE level of support that was equal to between two-thirds and three-fourths of the original implementation efforts. For those of you who just want to be done with it, I personally see “NO END IN SIGHT.” 6. Increasing realm of patient care. Patient care takes place throughout a continuum of providers that may in- clude the home, a physician offi ce, hospital and long-term care facilities. Many systems claim to be fully integrated, but most systems are not there yet. Some are on their way, but full integration has been elusive for most provider organizations. 7. Finally, the push for an EHR is on. Beginning with the Bush-era push for computerizing all of healthcare and continuing with Obama’s mandate and funding mechanisms to facilitate adop- tion and “meaningful use,” our business has taken some giant leaps forward. I, for one, believe it is about time. Back in a very early issue of Computers in Healthcare, I stated in an editorial, “Complete imple- mentation of a great clinical information system has the greatest potential to reduce costs and improve the quality of care of anything ever introduced into the fi eld of modern medicine; every other technology (although perhaps more wonderful) was cost-increasing technology.”


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8. All of America needs to be included.

We still need to fi nd a cost-effective way to bring rural and poor America into fully integrated information sys- tems technology. Tele-health may be part of the answer. 9. Choose with wisdom the right path. We need to be very careful that government mandates assist our efforts and not get in their way. I believe that providers and pri- vate-sector entrepreneurs can and will solve the problems at hand. My hat is off to the many nurses, CIOs, CMIOs, PMs, vendors, consultants and others who are making information systems work in healthcare. Most recently, David Blumenthal, M.D., and his team (and before him, David Brailer, M.D., and his team) did a wonderful job moving our mission forward at the national level. 10. Even greater change is coming. And last but not least, I believe we are in for some revolutionary changes in the way care is monitored and delivered, and we are not even halfway done with what we are doing under ARRA, HIPAA 5010, ICD-10 and meaningful use. I would like to address this in a future issue of this magazine, so please stay tuned!


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