Those were heady days in 1979 when I commenced my journey to a master's degree in the Program on Medical Information Science (MIS) in UCSF's Graduate Division.  I will be forever grateful to my brilliant, colorful, unforgettable professors -- Ron Henley, Marsden Blois, Tony Wasserman, Don Simborg, David Stimson, Azad Bolour, Hyo Kim and more -- people with fire in the gut and a fervor to change the world.

In those days, the electronic medical record (EMR) was the Holy Grail, the topic of several classes and of my master's project.  Amazingly, it remains a distant goal even today.  We are only beginning to implement the EMR in the majority of the medical institutions of this country.

Of course, in the intervening twenty-five years technology has made great strides.  Who of us MIS-ers will forget the day of the arrival of the mighty VAX?  The Department's pride and joy, it was the size of a washer and a dryer, demanded special air conditioning, and ran a DEC operating system that we promptly scrapped in favor of the upstart Unix, a software movement as political as it was technological.  Today, Linux, SunOS, and other Unix descendants are mainstream dull, but back then we were hell-raising nerds cobatting corporate hegemony.  Today, I write these words on my palmtop PC with more compute power than that roomful of VAX.  But less heat.

So why do most hospitals and clinics still use paper charts?  I volunteer at several San Francisco hospitals where the sheer volume of paperwork (and the resources it consumes) is mind-numbing.  Obstacles to the EMR are no longer technological;  today as twenty-five years ago they are primarily economic.  The EMR is infrastructure and largely invisible to patients.  What insurance company would choose to incur its added cost?  Though its contributions to quality of care are substantial and proven, the expense cannot be justified as could, say, a new MRI machine that provides a billable diagnostic or therapeutic service.  Yet progress is happening, spearheaded by Kaiser and its EMR vendor Epic.  UCSF's hospitals, too, have a huge EMR initiative underway.  How these changes are welcome!

When I started school at UCSF, my vision was a career that would wed medicine and computing.  The possibilities remain immense.  Especially in imaging, evidence-based medicine, and other applications of information technology, great leaps in quality of care have happened and many more are on the way.

Alas MIS, the program that nurtured my techno-medical zeal, no longer exists.  It drowned in a mire of politics, personalities, and above all economics.  Especially in today's climate of tight State budgets, it's nearly impossible to retain professorial talent when private sector paychecks are so much fatter.  However, the larger institution -- the Graduate Division of UCSF -- continues to provide a rich, nourishing environment in which programs like MIS -- and people like me! -- thrive and prepare to change the world.  Our teachers' fire burns on.