Databases in the next millennium

Predicting the likelihood that large databases will become an important instrument for medical quality improvement is at least as difficult as most prognostication. This attempt at prediction starts by trying to ask the right questions: Can data serve as the agent for meaningful improvement? Is meaningful improvement possible without data? What elements are necessary and sufficient for improving the quality of medical care? It then looks for answers, starting with an unconventional excursion into the history of database use. This is followed by a recognition that. the use of large databases for medical quality improvement is a true innovation, the future of which will probably be determined as much by the social and emotional forces that govern the diffusion of all innovations as by the technical strength of databases themselves. Finally, it examines some of the limitations and pitfalls that are likely to be associated with the increasing use of large databases in medicine.