Future history: medical informatics in geriatrics.

With deference to Isaac Asimov's The Foundation, which is the inspiration for this series, we briefly describe the "present history" of medical informatics (the application of information technology in medicine) in geriatrics, and then project a "future history" of this same endeavor. The older patient often has multiple acute and chronic problems that require management by a variety of medical professionals in a variety of settings. Proper care necessitates efficient gathering, integration, and management of information by each professional in each setting. As medical informatics evolves, we project that barriers to information exchange (both between providers and between providers and patients) will continue to decrease while the quality and relevance of exchanged information will continue to increase. The nexus of care will be the electronic medical record (EMR), which will shed its current paper chart metaphor and adopt an industrial process metaphor based on tasks and tolerances or goals. The multidisciplinary management of geriatric patients will strike a new balance: doctors, nurses, allied health professionals, family, and patients will all participate in the management of the patient's care. The EMR will coordinate data from a variety of novel sources, including wearable sensors monitoring physiologic parameters, falls, diet, ambulation, and medication compliance. The highly organized data in the EMR will allow explicit decision support for computer-facilitated, evidence-based care; will empower midlevel providers and patients with an increased role in the care plan; and will promote the realignment of care from hospitals/clinics to the patient's home.