Medical informatics' promised land: are we there yet?

A decade ago, a "promised land" was envisioned in which the true potential of medical informatics would be realized. A decade later, it is time to assess academic medicine's progress in its journey into this medical informatics promised land. To that end, the author considers how our academic medical centers have been affected by changes in social, financial, and technical forces originating either "inside" or "outside" these institutions. He describes how the Internet and the World Wide Web have brought about an explosion in the availability of biomedical information, eased communication across the globe, made more information available at a lower cost, and changed the pace of everyday work. Although he argues that academic medical centers have not always kept pace with these changes, information systems are improving as the leaders in academic medicine come to appreciate the value of both information technology and the people who understand it. To reach the "promised land" envisioned a decade ago, academic medical centers must treat medical informatics as a central component of their academic mission.