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Introduction

A few blocks from Cleveland Clinic's main campus, a vast white-walled space that formerly housed the Cleveland Museum of Contemporary Art is home to a company called Explorys. The employees are young and driven. They gather around one another's laptops and zip between meetings on Razor scooters. In a space that once showcased the most avant-garde painters and sculptors, these information engineers are forging a new kind of cutting edge—a revolution in the use of knowledge that will shape the future of healthcare.

The seed for Explorys was planted when a young physician and self-described "health IT nut" named Dr. Anil Jain came to Cleveland Clinic from Chicago for training in internal medicine. He arrived at a pivotal time in the 1990s, as Cleveland Clinic was in the initial stages of completely digitizing our patient records system—in retrospect, an enormous commitment. At the time, some small groups and hospitals were making forays into digital records, but no academic medical center of any size or stature was willing or prepared to "go all the way."

Appreciating the significance of this commitment requires an understanding of the massive amount of space needed to house the organization's paper medical records. It was an enormous basement area the size of a football field, filled with endless aisles of shelves jammed with folders containing the paper medical records of every patient who had visited Cleveland Clinic since 1921.

When Dr. Jain arrived at Cleveland Clinic, medical records personnel were still responding to requests for patient files by piling the folders into wheeled bins that traveled from floor to floor on metal tracks like cars in a mine shaft. Digitizing all the files would eliminate this cumbersome method of transport and the need to expand the shelving to accommodate an endless number of folders. The electronic medical record system would include putting a computer in every examination room, so that doctors could retrieve and add to patient records with a few keystrokes. All the information in the gigantic warehouse could be stored on a server the size of a household freezer.

Dr. Jain understood that the data stored in the electronic medical records not only were useful for immediate patient care but would also provide medical researchers with a wealth of knowledge. How would male patients between the ages of 50 and 60 with high blood pressure and a family history of diabetes respond to a particular drug regimen, administered in a particular way under certain specified conditions? How long would a patient who has had a given procedure need to stay in the hospital to heal? Before the advent of electronic medical records, there was really no way to answer such questions. The data had been buried; now they could be brought to light. To help access those data, Dr. Jain developed a Google-like search engine called eResearch that enabled Cleveland Clinic doctors and scientists ...

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