Fulfilling the Potential of Clinical Information Systems

Introduction Since the late 1950s, health care visionaries have predicted an information technology (IT) revolution within medical care delivery—a revolution that would transform the health care industry as it had the finance and retail sectors. The early pioneers of medical informatics— the study and use of computers and IT in health care—formulated a vision for literally transforming modern medicine through use of clinical IT systems. Many examples exist that show how such systems support management of health care outcomes, drug interaction checking, order entry, and electronic capture of a patient’s vital signs as well as clinical notes made by health care practitioners. Key advances in clinical IT can be a catalyst for early intervention in disease processes, improvement in health care outcomes and care management, reduction of medical errors, and increases in both administrative efficiency and patient satisfaction. Early estimates of the time needed to realize the promise of clinical IT applications in the United States were optimistic. In 1991, the Institute of Medicine’s Committee on Improving the Patient Record set a goal of making computer-based patient records a standard use of IT in health care by 2001. To date, however, the clinical IT revolution has eluded much of the US health care system, and the high expectations of past visionaries remain largely unfulfilled. Today, a few health care delivery systems have positioned themselves to overcome barriers to implementing clinical IT applications and have pioneered their use in US health care. For example, health care delivery systems such as LDS Hospital, the Mayo Clinic, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Kaiser Permanente, and the Veterans Health Administration (among others) have successful systems in place that represent multimillion-dollar investments made over many years—or decades. However, most health care practitioners and institutions in the United States are not well positioned either financially or in terms of organizational readiness to implement the IT infrastructure necessary to deploy clinical information systems.