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CONCLUSION

As we move into the twenty-first century, the promises of medicine are enormous, but so are the challenges and disparities. New technologies and therapies are developed every day, but so do the cost pressures. It is clear that medicine will need to undergo the same degree of retooling that other industries, such as the automotive and financial industries have, in order to remain viable.

Computers and computerized devices will clearly be integral to medicine’s survival in its current form. Both President George Bush and Senator Hillary Clinton have referred to the computerized provider order entry (CPOE) as essential to improved medical care at lower cost, so the message has clearly gotten to the highest levels of government. The adoption of tools such as CPOEs and electronic health records has proceeded slowly, however, despite a clear-cut consensus on the part of insurers, providers, and patients.

There are a variety of barriers that need to be negotiated before these tools become the norm. Privacy concerns are significant and grow with each new revelation of data loss by large companies and financial institutions. The implementation of the Healthcare Insurance Portability and Accountability Act (HIPAA) legislation has hit the industry like the Y2K “sea change,” however, and privacy protection is improving.

The medical software industry is nowhere near mature, and clinicians have been appropriately conservative in their adoption of products like CPOEs that have failed dramatically in some cases, such as Cedars-Sinai. There are, however, notable success stories and commercial vendors are delivering better products with improved sensitivity to the workflow issues inherent in converting to computerized ordering and record keeping.

The money needed to computerize is also needed at many institutions for infrastructure maintenance or to bring the physical plant into compliance with regulatory requirements. It is increasingly clear, however, that providers that are unable to become more efficient will fall increasingly behind more successful competitors. Computer supported medical care is like a claw or an eyeball: an evolutionary development that confers a competitive edge in an ecosystem under pressure.

Computer science and medical science have traditionally had little to say to one another. While there are a few outstanding medical informatics programs, such as those at Stanford, Vanderbilt, and Columbia, medical clinicians, be they physicians, nurses, or ancillary personnel, have had very little education about computers during their training. Happily, this is changing rapidly, with the integration of computers and digital devices into medical school curricula.

Recent trainees are much more comfortable with computers, software, and digital data. As a result, they are much more likely to accept well-designed products and integrate them into care delivery. While it is not yet clear exactly how medicine will change with computerization, the advent of technologies such as telemedicine, faster networking, and virtual reality give tantalizing glimpses of what it might look like. One needs only to look ...

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