Medical informatics is as much about computers as cardiology is about stethoscopes. For those who have studied the application of information technologies in medicine, the past decade has delivered one unassailable lesson. Any attempt to use information technology will fail dramatically when the motivation is the application of technology for its own sake rather than the solution of clinical problems.1 2 3

The role of the information sciences in medicine continues to grow, and the past few years have seen informatics begin to move into the mainstream of clinical practice. The scope of this field is, however, enormous. Informatics finds application in the design of decision support systems for practitioners,4 in the development of computer tools for research,5 and in the study of the very essence of medicine—its corpus of knowledge.6 The study of informatics in the next century will probably be as fundamental to the practice of medicine as the study of anatomy has been this century.

I will consider recent advances in medical informatics with two seemingly contradictory themes in mind—apparently unbridled technological promise against less than satisfying practical achievement—and against three criteria—possibility, practicability, and desirability. Possibility reflects the science of information—what in theory can be achieved? Practicability addresses the potential for successfully engineering a system—what can be built given the constraints of the real world? Desirability looks at the fundamental motivation for using a given technology.

These criteria are suggested because a framework is necessary to judge the claims made for these new technologies by those who seek to profit from them. Just as there is a longstanding symbiosis between the pharmaceutical industry and medicine, there is a newer and consquently less examined relation between medicine and the computing and telecommunication industries. Clinicians should try to judge the claims of these newcomers in …