Strategic action in health information technology: why the obvious has taken so long

Recent enthusiasm for the automation of medical records and the creation of a health information infrastructure must be viewed in the context of a four-decade history of anticipation and investment. To understand the current opportunities and challenges, we must understand both the evolution of attitudes and accomplishments in health care information technology (IT) and the cultural, economic, and structural phenomena that constrain our ability to embrace the technology. Because prudent IT investment could make a profound difference in U.S. health and disease management, our strategic response must begin with an understanding of the pertinent history plus the challenges that lie ahead.