311 Vol. 33, No. 4 The Keystone Papers: Formal Discussion Papers From Keystone III “Technology . . . is a queer thing. It brings you great gifts with one hand, and it stabs you in the back with the other (C.P. Snow [1905–1980], English novelist, scientist, government official). Introductory Scenario Gregg Samsa, MD, was not having a good day. He looked at and smelled the sandwich in front of him. It was not what he ordered. He had faxed his usual order for a lettuce, tomato, cucumber, and cheese sandwich to the local deli, but the fax had smudged and what he was about to eat was a lettuce, tomato, and Limburger cheese sandwich. It had been like this all day, starting early in the morn- ing when he accidentally sat on his palm computer and reduced the touch screen to rubble. Then, when he ar- rived at the office, he had 50 e-mails demanding a re- sponse. Five of the e-mails were from medical infor- mation services with which he had been registered by each of the five managed care plans he worked with. Each message identified three or four articles that he just had to know about, yet most of the articles dealt with problems he rarely saw, measured outcomes he didn’t care about, and didn’t answer his questions. An- other dozen e-mails were from pharmacies with ques- tions about five formularies—too bad his electronic medical record could only handle one formulary. The medical records also couldn’t do genograms, follow episodes of care, or link family members together. It was good at billing, however, which made sense because the group practice’s administrator had selected it. Another 20 e-mails were from patients, with ques- tions that ranged from the interesting to the inane. One message was from a mother whose mentally retarded son had tuberous sclerosis. Someone on a Web-based support group had suggested that patients with tuber- ous sclerosis should have annual renal ultrasounds since they could develop tubers in the kidneys. What did Dr Samsa think should be done? Dr Samsa didn’t have a clue since this was his only patient with tuberous scle- rosis. After considerable effort, he determined that tu- bers infrequently caused renal failure, and there was not much that could be done about them, anyway. How- ever, he could not convince her that screening was a waste of time and money. The most annoying e-mail came from the State Health Department. They informed Dr Samsa that their routine computerized screening of controlled drug pre- scription patterns had revealed that Dr Samsa’s prescrip- tion of benzodiazepines was outside the predicted range. Would he please forward within 10 days the electronic records of all patients for whom he had prescribed ben- zodiazepines in the past year to the Health Department for their review. As he smelled his sandwich, Dr Samsa reflected that sometimes the technology revolution smelled too. He longed for the good old days when television was black What Can Technology Do to, and for, Family Medicine? Mark H. Ebell, MD, MS; Paul Frame, MD From the Department of Family Medicine, Michigan State University (Dr Ebell); and the Department of Family Medicine, University of Roch- ester (Dr Frame). Medical technology can be divided into information technology, diagnostic technology, and therapeutic technology. These technologies can enhance the care of patients in a family practice; they also have the potential to diminish or fragment family practice when the technologies can only be provided by special- ists. While some family physicians have an aversion to technological advances, we believe it is imperative that family physicians participate in the development of technologies that enhance family practice and improve patient outcomes in primary care practice. These include electronic medical records, decision support systems, tools for managing medical information, and others. Criteria are presented to help determine when these new technologies should be adopted into practice. (Fam Med 2001;33(4):311-9.)