power of combinatorial chemistry in the search for new drugs, providing, as in the case of molecular biology, the means for ordering and analyzing huge data sets. Another promising direction in the future is the modeling of organ systems and whole organisms, a field that has been labeled physiomics. Here, computational power provides the ability to capture a vast number of parameters related to the physiology of an individual, to model that individual’s biological responses to a drug or a combination of drugs, and thereby to customize drug therapies to an individual, reducing the uncertainties and side effects that are a feature of current drug use.

Physiomics is not without its challenges and problems. Since the validity of the models it generates and manipulates depends on the accuracy and completeness of our understanding of the biology response functions involved, the move from a clinical or laboratory setting to a computer terminal must involve a true bridging of the biomedical sciences and information technologies, a partnership between scientists in both disciplines, and the capacity to communicate in both directions.

At the clinical level, information technology has made possible major advances in imaging techniques, and there is every indication that the next decade will see a continuation of that trend. However, it is not so much overwhelming computational power that is most important as it is our ever-increasing ability to miniaturize chips that have modest, but adequate, computational capacity to be usefully incorporated in implanted sensors or in MEMS devices. Intelligent sensors based on microchips are now commonplace in heart pacing and implanted defibrillation devices. Insulin pumps can be driven by implanted glucose sensors. But microchips are likely to provide the key enabling technology in the next several years by allowing the design of MEMS devices for use in microsurgery, motor control in replacement body parts, in situ drug delivery, and a host of other applications.

Finally, there is the enormous potential for information technology to facilitate the storage and transfer of information about patients between and among different departments of a health care facility and between health care facilities. It has already been demonstrated that information technology has the potential to reduce errors in drug dispensing; to automate patient monitoring either directly if the patient is in a health care facility or through a simple analog telephone connection if the patient is at home; to store and transmit x rays and other images from one facility to another; or to store a patient’s entire medical record on a wallet card. The fact, however, is that health care has seriously lagged other industries in incorporating information technology into its operations. That, combined with the opportunities that will come in these next years as computational speeds and communication bandwidths increase, suggests to the committee that there will need to be significant catch-up in this area in the next decade.



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