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Charting a Course for the 21st Century – NLM's Long Range Plan 2006-2016

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Health Care System

A fundamental observation guiding this vision for the Library in coming decades is that publication and reading are necessary but insufficient mechanisms to turn knowledge into effective action in the 21st century. A healthcare enterprise that depends principally upon the cognitive capacity and reliability of autonomous individual practitioners and their interpretations of what they read will continue to be error-prone and have unacceptably high rates of suboptimal disease prevention, diagnosis and treatment. In the future the informed and "activated" consumer will play an increasingly important role in error prevention.

A systems approach to health care and public health, like the systems approaches to aviation safety and knowledge management in other complex industries, will depend increasingly upon "executable knowledge" in the form of computerized logic that embodies the collective best understanding and best practice for health-related practices.

Stated differently, in addition to patients, families, and the public, the Library’s newest and fastest growing group of users may be intelligent devices.

By 2025, we will have left behind a world of very expensive, personally held knowledge in which people with trained intuitions based on years of education and practice could produce acceptable results in either health care or research. A worldwide Internet based cyber-infrastructure of knowledge provided in real time and mediated by expert systems exploring massive databases will be useful tools for healthcare and research. The health sciences will likely share some of the infrastructure with other scientific disciplines as part of the new world of e-science, both within the U.S. and internationally.

This infrastructure will support ubiquitous telemedicine capability allowing a trained community health aide anywhere on the globe to obtain and transmit diagnostic image and test information and obtain timely expert advice on appropriate handling and immediate treatment of patients with a wide range of conditions. Using wireless diagnostic tools produced at commercially sustainable costs, this trained aide may be able to identify and treat an increasing number of problems locally.