Clinical information systems in intensive care.

OBJECTIVE To review the requirements and functions of clinical information systems for the critical care environment. DATA SOURCES Peer reviewed studies and articles reported from 1990-1998, identified through MEDLINE search and subsequent article references. SUMMARY OF REVIEW Clinical information systems (CIS) utilise information technologies to improve and add value to information management, and critical care areas have provided clinical leadership in their development and implementation. Expectations for these systems are high, yet certain basic requirements must be fulfilled. Bedside charting functions of CIS are highly developed and successful. Clinical record keeping has been more challenging, particularly the requirement for electronic storage of a medico-legal record. Decision support ranges in its extent and requires further development. Successful integration with other hospital systems is highly desirable but may be made more difficult by the lack of rigorous technical standards in healthcare computing. The CIS clinical database is fundamental to the quality improvement, research and business reporting functions. The huge amount of data, the lack of common minimal and extensive data sets, and the technical challenges of software development, all combine to make this a resource expensive venture requiring on site customisation. Purchasing and implementing a CIS is costly in human and material resources. CONCLUSION A high performance CIS is not yet available as an 'off the shelf' product. Close collaboration between the industry and clinicians is important for successful implementation. Clinical awareness of these issues will encourage product development and suitable purchasing strategies.