One of my favorite cartoons by John Chase shows a drunk holding a bottle while sitting in an alley looking at a normal distribution curve on the wall with an ‘x’ marking a very early point on the curve; the caption says ‘You are here.’ It still feels that way at times in biomedical informatics. With respect to healthcare transformation and the contribution we all hope biomedical informatics will play, it nevertheless feels as though we are still early on—there have been many significant contributions from our field, but there are many more to go.#N##N#Certainly the healthcare environment is changing dramatically under our feet. The evolution from healthcare reimbursement based upon fee-for-service and maximizing volume of care delivered toward reimbursement based upon bundled (or at risk in any form) payments and maximizing the value of care delivered will take at least a decade, or more.1 ,2 The aging population is increasing the burden of chronic disease, and the shift from commercial to public insurance is reducing once generous healthcare margins to the minimum. Times are tough all over. If the fundamental theorem of informatics …
['Blackford Middleton']
Chairman's column: health informatics and healthcare transformation—entering the post-EMR era