State of the art in clinical informatics: evidence and examples.

OBJECTIVE The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. METHODS In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security. RESULTS Substantial progress has been made in demonstrating that various clinical informatics methodologies and applications improve the structure, process, and outcomes of various facets of the healthcare system. CONCLUSION Over the coming years, much more will be expected from the field. As we move past the "early adopters" in Rogers' diffusion of innovations' curve through the "early majority" and into the "late majority," there will be a crucial need for new research methodologies and clinical applications that have been rigorously demonstrated to work (i.e., to improve health outcomes) in multiple settings with different types of patients and clinicians.