gms | German Medical Science

In medical informatics today we have both old problems and new opportunities. Prominent amongst the old problems is the familiar dilemma of our technical and scientific capabilities greatly exceeding the social and political ability of people to cope with the changes our information systems offer.

In the computer based medical record, for instance, some see the opportunity for improved patient care, error reduction, cost containment, and discovery of new clinical features of disease, treatment, and complications. Others see only more clerical work for doctors and greater control of medicine by managers.

In the emergence of nationwide and international standards in medical information technology, some see opportunity for achieving the lifelong medical record by linking and unifying the currently fragmented episodes of healthcare. Others shy away because they fear potential or enhanced political control of selected populations. Our brightest opportunities for progress and discovery in medical informatics continue to accentuate this historic dualism: the view of trust and optimism versus the view of cynicism and pessimism. There are good reasons for both views - even for a combination of the two. Yet, destiny offers us some remarkable new opportunities.

First, large prospective observational patient trials can now be planned. These will be necessary in order to clarify the ways in which human genes produce or interact with each other to produce our many human phenotypes. Conduct of such trials (very greatly magnified Framingham, Massachusetts studies) will require computer based record keeping, including the results of genetic testing of the study and reference populations.

Second, in the category of "small sciences," we can see the possibility to clarify what good purposes are served by traditional print publications, and what purposes could better be served by truly electronic communication/publishing. Now that computers and networking have managed to distribute scientific journal articles as proper counterfeits of the print page, now we can investigate what would true electronic publication do for us? In a cardiology journal, for instance, shall we be able to hear the heart sounds, to view the EKG for abnormalities of rhythm, to listen to the patient's respiration? Will it be important enough to our improved understanding and learning that the angiogram be "playable" as a continuous perfusion rather than as a single static picture that shows (or misses) the luminal obstruction? Would journal readers prefer to access an actual functional MRI or CAT-scan and to apply their own scan-windowing and contrast control rather than see a single picture? The two research opportunities cited will both, no doubt, be accompanied by fears of misuse of science, but both offer progress in science as well. Surely, we shall find the right way to find progress.