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J Am Med Inform Assoc. 2000 Mar-Apr; 7(2): 204.

The Cornerstones of Medical Informatics

The changes in the health care system over the next decade are goint to make the last 20 years seem like good old days of relative stability. We will continue to see new drugs, new devices, and new techniques; however, the true megachanges of the next decade will center on gathering, managing, and using clinical information. This prediction will prove true for all the health care areas—administrative, clinical, teaching, and research.

In health care today, we see pressures for improved access, demands for greater economic efficiency, the development of vertically and horizontally integrated delivery systems, heightened emphasis on wellness, and the transition to medicine based on an understanding of the human genome. All these will continue to create dramatic change in roles and responsibilities in the system. Yet true re-engineering of the health care information management infrastructure has hardly begun.

Although information system consultants and vendors are flocking to offer solutions, these solutions still tend to follow old paradigms. Money is being wasted on information systems that are barely adequate for the present and that offer little or nothing for the future. The development of a new, robust information management paradigm is the critical challenge facing the health care industry.1,2

Four cornerstones of medical informatics form the basis for developing a new information management paradigm for health care.3 These four cornerstones of knowledge and expertise extend well beyond the skills associated with traditional data processing and information systems.

  • Producing structures to represent data and knowledge so that complex relationships may be visualized
  • Developing methods for acquisition and presentation of data so that overload can be avoided
  • Managing change among people, process, and information technology so that the use of information is optimized
  • Integrating information from diverse sources to provide more than the sum of the parts, and integrating information into work processes so that it can be acted on when it can have the largest effect.

The 1999 AMIA Annual Symposium featured a state-of-the-art session for each of these cornerstones. The presenters have recast their thoughts into written papers. These papers, together with edited comments from the discussion at the sessions, appear in the Mar-Apr and May-Jun issues of the Journal.

The 1999 Symposium's Cornerstone presentations demonstrated that significant informatics implementations rest on a four-legged base, with all four legs being essential to success. These cornerstones must come together in an integrated fashion to deliver the types of knowledge that informatics is capable of delivering to support our future health care systems.


1. Greenes RA, Lorenzi NM. Audacious goals for health and biomedical informatics in the new millennium. J Am Med Inform Assoc. 1998;5: 395-400. [PMC free article] [PubMed]
2. Stead WW, Lorenzi NM. Health informatics: linking investment to value. J Am Med Inform Assoc. 1999;6: 341-8. [PMC free article] [PubMed]
3. Lorenzi NM, Gardner RM, Pryor TA, Stead WW. Medical informatics: the key to an organization's place in the new health care environment. J Am Med Inform Assoc. 1995;2: 391-2. [PMC free article] [PubMed]

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