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How the Past Teaches the Future

ACMI Distinguished Lecture

Affiliation of the author: Duke University, Durham, North Carolina.

Correspondence and reprints: W. Ed Hammond, PhD, Box 2914, Duke University, Durham, NC 27710; e-mail: <hammo001{at}mc.duke.edu>.

More than 30 years of experience in developing a computer-based patient record system, The Medical Record (TMR), in multiple settings, in multiple specialty groups, and at multiple sites has taught us many lessons. Lessons related to computer-based patient records include the importance of a data model in which input, storage, and planned use are independent; separation of patient-specific data from metadata; a modular design to localize the program code that deals with a set of data; redundant storage to optimize tasks and response time; and integration of decision support into work process. Lessons related to medical informatics include the importance of a clinical–technical partnership, control of tools at the leading edge, and rapid prototyping in the real world. Finally, changes in technology move the challenges but do not eliminate them.

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