Many of us look forward with anticipation to the potential benefits to be derived from large-scale distributed medical information systems. The next decade will see a great deal of experimentation, particularly in the organization of information within databases, the design of user interfaces, and the introduction of new technologies such as wireless communication. I believe that we must resign ourselves to the fact that a great deal of the money that is invested will later be viewed as less than successful. It is important during this time to keep clear view of the fact that the ultimate goal is to have universally accessible and transferable records.
The sudden realization that the Internet can be used to make money has been greatly tempered by the simultaneous realization that the Internet is sadly lacking in adequate security methodology. Luckily, money has a way of solving many problems in life, and I expect that the financial rewards possible on the Internet will fuel a concentration on developing better and cheaper security technologies. This is particularly true for the development of digital signatures and a key certification hierarchy infrastructure, since digital signatures are the key to enabling electronic commerce. We have already seen a rapid acceleration in the process of standards development within ANSI X9 and ANSI X509.
The transition to an electronic record will however require some change in habits of the health care community, since things that have seemed routine will no longer be needed, and things that we took for granted under the previous system will no longer be true. It is important that the transition to an electronic record should at the very least preserve the same degree of assurance for the integrity of medical records that the paper record held. Luckily this should be possible, but it will not be free. Vigilance will be required to maintain the momentum toward securing our medical information.