Public healthcare information technologies or ‘medical informatics’ may very well be-come the preeminent medical development of the 21st century, akin to the breakthrough role antimicrobial therapies played starting in the late 19th century and the impact that genomics were starting to have in the 20th century. If current trends prevail, large-scale data management systems, fueled by the combination of rapid developments in medical information systems and rapidly decreasing costs for data storage and retrieval, will be connected almost directly to all but the most remote or destitute of medical practices anywhere in the world. Currently, United States government agencies collect a wide variety of hospital discharge data on most inpatients. With such administrative datasets, it is then up to the holder of the data to determine how our practices are rated and what support we will receive for our care delivery in the future. Never mind that some items such as ‘hyponatremia’ (one of the currently collected screening values) will likely have little or next to nothing to do with the quality of care that a spine surgery patient may have received. If a patient turns up ‘hyponatremic’ on a federal discharge database it results in a demerit for the practitioner and the hospital without chance for appeal or explanation. Are current practices, such as recording a sodium level, the harbinger of quality of care for remote specialties such as spine surgery in the future? Probably not, but it isn’t all that farfetched to imagine comprehensive data sets being gathered to screen our practice patterns. The sophistication of data gathering will undoubtedly grow, allowing for iden-tifi cation of blemishes and real complications alike in an unprecedented fashion. From there it is but a small step to envision future healthcare systems that are driven by data analysis of apparent ‘evidence’ to decree treatment decisions based on abstract principles without the power of human touch. This is the tipping point where the currently popular, but largely irrelevant ‘guidelines’ (usually turned out by professional societies) will be rendered completely irrelevant by implementation of healthcare ‘policies’ decreed by governmental organizations and powerful third-party payor corporations. This vision is very much in keeping with the dystopian prophecies of author George Orwell, perhaps most well known for his bestsellers “Animal Farm” written in 1945 and “Nineteen Eighty-Four” written in 1949, who predicted healthcare being administered through a remote healthcare bureaucracy that took it upon itself to decide what was best for its citizens. The current, undeniably fascinating, leap in information technology could indeed result in the realization of the Orwellian nightmare: healthcare decreed by ‘careless’ anonymous bureaucratic calculation with, human disease and its treatment reduced to a formula and issued in the form of a mandated decision.Aside from this nightmarish scenario—are there some potential benefi ts for patient care inherent to a progressive implementation of healthcare informatics? Sure! There are fi ve major points that immediately come to mind:• Rare diseases will become much more transparent with modes of detection and treatment as long as they are well-identifi ed a priori in large-scale data gathering.
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