Medical Informatics 2040: Radical Reengineering and Transformation of Healthcare in the 21st Century

Shepherdstown 04 November 2007In a recent book entitled "Medical Informatics 20/20" published by Jones & Bartlett earlier this year, the authors talk about key management strategies and selected health information technologies that healthcare executives should be focused on over the coming decade. The management strategies include Collaboration, Open Systems, and Innovation (COSI). The key health information technologies include Electronic Health Record (EHR), Personal Health Record (PHR), and Health Information Exchange (HIE) systems.


They projected that in the U.S., by 2020:

  • 80 percent of healthcare provider organizations will have implemented EHR systems; 20 percent would still lag behind and not be there.
  • 80 percent of the general population will have started using PHR systems; 20 percent of the population would not.
  • 80 percent of EHR and PHR systems will be linked via HIE systems; 20 percent of these systems across the country would still not be connected.

While achieving those objectives will lay the foundation for dramatically improving healthcare, radical reengineering and transformation of healthcare will start to come about when the following emerging health information technologies are eventually implemented in the coming decades:

  • Genomic Information Systems & BioRepositories
  • Nanotechnology & Implantable Health IT Systems
  • Medical Robotic Systems
  • Wearable Health IT Systems

By 2020, these emerging solutions will be used by less than 20 percent of healthcare providers and patients in this country. However, the time has come to start focusing our attention on these cutting edge technologies and how they will be employed to further transform healthcare over the coming decades. There are still many technical, legal, ethical, social, and other issues that must be addressed before widespread implementation of these systems occur in the 2020-2040 timeframe.

Future Scenario - 2040

By 2040, it is conceivable that every U.S. citizen will be required to have an entry in a national biorepository and genomic information system. This will be needed for a wide range of reasons from national security, public health, immigration control, citizen identification, resolution of crimes, and more. Genomic information systems will be integrated with EHR and PHR systems and will allow for early identification and treatment of individual disease/healthcare issues. Hard data will be yielded from these systems that will allow providers to better treat their patients, for the government and researchers to target time and resources on specific diseases/conditions. Medical schools and provider organizations will be able to train and employ the right mix of specialists to treat their patient population. The focus of healthcare will shift more dramatically to preventive health practices rather than current practice of treating patients after the fact.

By 2040 most citizens will have made the choice to have an implantable nanotechnology device that will be tailored to meet a number of their personal healthcare requirements. For example, these interactive implantable medical devices could be used to more accurately identify patients who are unable to communicate, for some reason. The device could be programmed to contain key clinical information about a patient in an emergency care situation. The device could be programmed to be used as a tracking device for Alzheimer patients. Based on one's genomic information, the implantable device could be programmed to monitor specific conditions, and to dispense medication as needed while simultaneously alerting one's healthcare provider. The implantable medical device would be able to wirelessly communicate or interact with the more robust, 'smart' EHR or PHR systems of the future.

By 2040, a number of other emerging technologies such as medical robotics and wearable health IT systems will have evolved and be widely deployed. Complementary & Alternative Medicine (CAM) information modules will be incorporated into more robust, 'smart' EHR and PHR systems of the future as healthcare goes global and embraces knowledge and effective healthcare practices from other cultures. These technologies and solutions will complement and further support the continuing evolution of healthcare.


It is time for the more forward thinking health IT executives to begin the process of shifting the emphasis of their strategic thinking out to the 2040 timeframe. Radical reengineering and transformation of healthcare will not occur as a result of acquiring and implementing EHR, PHR, and HIE solutions that are currently attracting 80 percent of our current investment and attention. It is only when we couple the innovative, cutting edge technologies (e.g. genomics, implantables, nanotechnology, robotics) with the EHR, PHR, and HIE systems that radical changes really start to happen. These emerging technologies currently garner less than 20 percent of our investment and attention, yet looking ahead, they will provide 80 percent of the tangible benefits to be reaped from embracing new solutions. Leading healthcare provider organizations should consider collaborating with other organizations on pilot projects utilizing these innovative, cutting edge health IT solutions.

Selected References

(Also, see This HHS report, "Personalized Health Care: Opportunities, Pathways, Resources", presents a long-range plan for achieving more individualized treatment for patients, especially by using genetic information and healthcare information technology.)


Peter J. Groen spent more than 30 years as a hospital CIO and other senior health IT positions. He is currently an adjunct faculty member of the Computer & Information Science Department at Shepherd University in West Virginia and is one of the founders of the Shepherd University Research Corporation - see

Peter Groen

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