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Deep disorder pervades medical practice. Disguised in euphemisms like “clinical judgment” and “evidence-based medicine,” disorder exists because medical practice lacks a true system of care. The missing system has two core elements: standards of care for managing clinical information, and electronic information tools designed to implement those standards. Electronic information tools are now widely discussed, but the necessary standards of care are still widely ignored. Because these two elements are external to the physician’s mind, they address a root cause of disorder: dependence on the internal capacities of autonomous physicians—their personal knowledge, intellect, habits and judgment. In this dependence on the limited, idiosyncratic capacities of individuals, medical practice lags centuries behind the domains of science and commerce. Breaking that dependence is the subject of this book. Going back 400 years to the philosophy of Francis Bacon, and examining parallel ideas from 20th Century thinkers, this book illuminates the origin of medicine’s disorder. The analysis is more than theoretical. It grew out of decades of development and clinical experience in finding a new approach to medical practice. Designed to create order and transparency, this new approach involves not only standards and tools but also institutional changes essential to building a true system of care. In the current non-system, physicians bear impossible burdens of performance, other practitioners are barred from sharing those burdens, patients do not participate effectively in their own care, the U.S. spends $2.5 trillion annually without clinical accounting standards, third parties manipulate the situation for their own advantage, and none of the stakeholders are accountable for their own behaviors. This book offers a clear blueprint for building a better system of care, a system that patients, practitioners and third parties could trust. A better system could make health care a source of hope for our economic future, rather than its greatest threat.

Lawrence L. Weed is a physician who, more than 50 years ago, originated influential standards for organizing medical records. He applied these standards (known as the problem-oriented medical record) in designing electronic record systems. He subsequently developed software tools for applying medical knowledge to patient data. His son Lincoln practiced employee benefits law in Washington, D.C. for 26 years and now specializes in health privacy at a consulting firm.