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Healthy Policy and Systems
Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics.
Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues.
Methods: Literature review and analysis.
Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.
JOURNAL OF NURSING SCHOLARSHIP, 2001; 33:1, 75-81. (C) 2001 SIGMA THETA TAU INTERNATIONAL.
[Key words: information systems, nursing informatics, HIS, DSS, computer-based patient records]
During the late 20th century, information systems (IS) have become increasingly prevalent in healthcare. What were the influences that led to early advances in clinical computing? What are the current trends in clinical computing, and what can nurses expect in the future? This article is a synopsis of these issues for nurses not schooled in informatics. Although this discussion is specific to American health care facilities, the findings may apply in other countries as well.
Historical Influences of Information Systems in Clinical Care
The development of IS has been linked to changing needs in the healthcare industry. The U.S. healthcare industry in the 19th century was a charitable, community-based effort to care for the sick and needy (Kissinger & Borchardt, 1996) and was comprised of stand-alone healthcare services for episodic, acute care. Patients' records were maintained by healthcare providers with little need to share information among providers or settings.
Throughout the 20th century, the healthcare industry expanded, fueled in large part by the federal government. In the 1950s, the emphasis was on increasing the number and quality of healthcare facilities. The Hill-Burton Act provided funds...