title: How the past teaches the future: ACMI distinguished lecture.
abstract: 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.
authors.affiliation: Duke University, Durham, North Carolina 27710, USA. hammo001@mc.duke.edu
authors.forename: W E
authors.initials: WE
authors.lastname: Hammond
mesh_terms: D049673:History, 20th Century; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000266:history*; D008905:Minicomputers / Q000266:history; D019095:Point-of-Care Systems / Q000266:history; D012984:Software / Q000266:history; D014481:United States; D018875:Vocabulary, Controlled