I've been reading a fascinating book recently: An Edible History of Humanity, by Tom Standage, a journalist and historian, which was published in 2009. The book deftly combines history, anthropology, and pieces of several other disciplines, and applies them to the question of how changes in food consumption, discovery, production, and exploitation might have influenced the history of human society. In fact, as Standage carefully explains, patterns of activity around food have shaped, and at times even rocked, human societies, from the dawn of agriculture thousands of years ago to the mass collectivization schemes of Stalin and Mao in the 20th century. It's a surprisingly dramatic and insightful read.
WE'LL LOOK BACK ON THIS PERIOD AND SEE IT AS AN IMMATURE PHASE OF DEVELOPMENT IN CLINICAL IT, ONE PARTICULARLY BESET BY STRUGGLES AROUND ADOPTION.
One whole section of the book relates the rise (and fall and re-rise) of the potato, which began its life as a staple of the diet of the Inca peoples of South America, and eventually conquered Europe, before an over-reliance on the tuber led to the Irish potato blight, which caused horrific famine in Ireland and other countries in the middle of the 19th century.
As the author writes, “At the beginning of the seventeenth century, potatoes were widely regarded as suitable fodder for animals, but to be eaten by humans only as a last resort.” But one man, Antoine-Augustin Parmentier, a French scientist, who had lived on potatoes for more than three years as a prisoner of war in Prussia, was determined to popularize the tuber. One of his most successful gambits was, with the support of King Louis XVI, to post armed guards around the fields outside Paris, given to him by the king, where he was growing potatoes. That stratagem intrigued the local peasants, who rushed in to steal the potatoes once the armed guards were withdrawn. As hostility toward the potato finally crumbled, the king told Parmentier, “France will thank you some day for having found bread for the poor.” Later in the book, Standage discusses how over-reliance on the potato led to the terrible potato famine, despite some experts’ warnings decades before.
The Standage book is generally fascinating, and the Parmentier story illustrates how difficult it can be to get people to adopt new habits and patterns of activity. What about efforts in the present to foster the adoption of the core clinical information technologies-including EMR, CPOE, eMAR, advanced pharmacy, RIS, PACS, and the like-that have the potential to transform the quality, safety, and efficiency of patient care delivery?
I believe that 10 years from now, we'll look back on this period and see it as an early, immature phase of development in clinical IT, one particularly beset by struggles around adoption. Still, things are advancing rapidly in certain areas. In this issue, our cover story discusses the advances being made in the adoption of evidence-based decision support in the diagnostic and ordering processes of care, while we also present a feature on how the pioneering patient care organizations are using advanced data warehouse strategies to fuel progress on meaningful use.
While no one is having to resort to clever tricks to get people to eat potatoes in this day and age, there is an analogy there in terms of the lengths to which healthcare IT leaders are having to go in order to induce clinicians to adopt core clinical information technologies. It will be fascinating to look back years from now on this period. I'm guessing we'll be able to look back and see some Parmentiers currently in our midst, leaders who took exceptional risks at crucial moments, to help move our healthcare system forward to adopt transformative technologies for the future.
Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 January;28(1):8