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Introduction

"If you are ever in a situation where you cannot speak for yourself, your electronic medical record will speak for you." That's what I said on Thursday, January 27, 2005, from my place on a stage that had been so recently built that it still smelled of sawdust and glue. It was just one sentence in my 15-or-so minutes of prepared remarks; and while I couldn't possibly have known it at the time, I have since come to realize that it is probably the single most prescient sentence I have ever uttered; it is the one that has had the greatest impact on the integrated health information technology work we have done at Cleveland Clinic during the past 15 years; and it will, I am sure, continue to inform the work we will do for years to come.

Here's why …

Along with several others, I shared the stage with the president of the United States, George W. Bush, who was visiting Cleveland Clinic to promote a national initiative he had formally introduced during an address he delivered on April 26, 2004, when he announced that, "Within ten years, every American must have a personal electronic medical record."1

We were in the grand ballroom of the brand-new Intercontinental Hotel on Cleveland Clinic's main campus. Somewhere out in the darkness beyond the klieg lights was an overflow crowd of Cleveland Clinic employees, philanthropic supporters, political dignitaries, local residents, and, crucially since he would in short order become instrumental in the next phase of the advanced technology work that thousands of Cleveland Clinic caregivers were doing, Delos "Toby" Cosgrove, MD, the world-renowned cardiothoracic surgeon who had assumed his duties as Cleveland Clinic's president and chief executive officer2 in January of the previous year.3

The name of this particular town hall style event was "Improving Care and Saving Lives Through Health IT."4 And according to the members of the White House advance team who had become my personal "handlers" since we were informed of the president's intention to visit our organization, the whole reason that I was on stage that day was to explain the benefits of electronic medical record (EMR) technology in a way that would be meaningful to the American public—which was an assignment that had been keeping me up at night for weeks.

This was 2005, and I was enough of an industry insider to know that public awareness about health information technology in general, and EMRs in particular, hovered at around zero. (Actually, according to a survey conducted the year before by an emeritus professor of public law and government at Columbia University, 29 percent of participants claimed to have "read something" about EMRs,5 which, believe me, sure felt like zero.) Also, at the time, only about 20 to 25 percent of U.S. hospitals had adopted any portion of an EMR ...

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