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The provision of healthcare is remarkably information intensive. A large integrated healthcare system processes tens of millions of information exchanges per day, through multiple pathways, including its electronic health record, as well as via beepers, text messages, and e-mails.

But high volume is just the beginning. Consider the task of tracking a single patient's current diseases, past medical history, medications, allergies, test results, risk factors, and personal preferences (such as for cardiopulmonary resuscitation). Tricky? Sure, but now do it over months or years, and then add in the fact that the patient is seen by many different providers, scattered across a region, often using different medical record systems that generally do not communicate with one another.

Want more? To make payment decisions, the insurer needs access to some of this information, as does the source of the insurance, which in the United States is often the patient's employer. But, because of privacy concerns, both should receive only essential information; to tell them of the patient's HIV status, or her psychiatric or sexual history, would be highly inappropriate, damaging, and possibly illegal.

Now let's make it really hard. Assume that the patient is in a car accident and taken to an emergency department (ED) in a nearby state, where she is stabilized and admitted to the hospital. Ideally, the doctors and nurses would see the relevant clinical details of her past history, preferably in a format that highlighted the information they needed without overwhelming them with extraneous data. Orders must be processed instantaneously (none of “the system is down for planned maintenance” or “orders are processed on the next business day” so familiar from commercial transactions). During the patient's hospital stay, not only would there be seamless links among all of the new observations (the neurosurgeon can easily view the ED doctor's notes; the resident can quickly find the patient's vital signs and laboratory studies), but also the various components would weave together seamlessly. For example:

  • The system would prompt the doctor with information regarding the appropriate therapy or test for a given condition (along with links to the evidence supporting any recommendations).

  • The system would warn the nurse that the patient is allergic to a medicine before she administers it.

  • The system would tell the doctor or pharmacist which medications are on the formulary and steer them to the preferred ones.

Meanwhile, the vast trove of data being created through this patient's case—and millions of others like it—would be chronicled and analyzed (“mined”), searching for new patterns of disease, evidence of preferred strategies, and more. All of this would be iterative—as new information emerged from this and other research about disease risk factors or best practices, it would seamlessly flow into the system, spurring the next patient's care to be even better.

Contrast this vision of information nirvana with the prevailing state of most ...

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