In the 1950s, computers were mammoth machines, rightly thought to provide utilitarian services like the electric company or public works. The field of informatics launched in the 1950s. The American Medical Informatics Association defines it: “Biomedical and health informatics applies principles of computer information science to the advancement of life science research, health professions education, public health, and patient care. This multi-disciplinary and integrative field focuses on health information technologies and involves the computer, cognitive, and social sciences.”
Many contributed to the maturation of the field of informatics, but I want to highlight the work of one pioneer, Dr. Larry Weed. Every EHR follows Dr. Weed’s structure for documenting patient care, the problem-oriented medical record. Every clinician today uses Dr. Weed’s problem-oriented design for the medical record. Clinical notes were a mishmash of unstructured text before he published his seminal article in 1964.
In 1969 at the University Medical Center in Burlington, VT, Dr. Weed developed PROMIS, the Problem Oriented Medical Record System, which integrated every aspect of healthcare from front office administration to procedure and laboratory fees to patient treatment. Dr. Weed being many years ahead in his thinking, led to the system not being widely accepted.
In later years, Dr. Weed built the Problem-Knowledge Coupler, a diagnostic clinical decision support system based upon probabilities gleaned from large data sets and extensive clinical review. In retrospect, this may have been the first AI large language model in healthcare, although rudimentary at best.
Dr. Weed also championed using computers to document clinical care to reduce the documentation burden of physicians, something he promoted many years before the widespread use of the EHRs and their contribution to physician burnout.
Many others helped develop the field of informatics, and I encourage you to learn about them. Today, we can access the world’s knowledge from a rectangular device in our pocket and use it to great advantage in our lives. It is time for healthcare to use information technology tools more effectively to change healthcare to better serve patients, clinicians, and society.
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