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The changes in the health care system during the next decade are going to make the last twenty years seem like good old days of relative stability. The past twenty years have seen tremendous changes-new drugs, new devices, and new techniques. These changes will certainly continue, but the true megachanges of the next decade will center around gathering, managing, and using clinical information. This prediction will prove true for all the health care areasadministrative, clinical, teaching, and research. Yet we make it at a time when most health care information is still being managed manually and in ways that can be charitably described as “refinements” of the 1975 information management paradigm. True reengineering of the health care information management infrastructure has hardly begun. The press for improved access to health care, the expectation of having health care provided at lower cost, the development of vertically and horizontally integrated delivery systems, the emphasis on wellness, and the transition to medicine based on an understanding of the human genome are creating dramatic changes in roles and responsibilities in the health care system. Although information system consultants and vendors are flocking to offer solutions, these solutions still tend to follow old paradigms. Millions of dollars are being wasted on information systems that work barely adequately 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. Four cornerstones of medical informatics form the basis for developing a new information management paradigm for health care. These four cornerstone areas of knowledge and expertise extend well beyond the skills associated with traditional data processing and information systems and include:

Medical Informatics: The Key to an Organization's Place in the New Health Care Environment