The Future of Clinical Information Systems in Healthcare: Challenges for Researchers in Clinical Informatics
  • Health care in the information society. A prognosis for the year 2013 -- Haux R, et al. Int J Med Inf 2002 Nov;66(1-3):3-21.
    Three factors will greatly influence the further development of information processing in health care within the near future: the development of the population, medical advances, and advances in informatics. These factors have motivated us to set up 30 theses for health care provision in the year 2013. The theses cover areas of health care, such as its people, its information systems, and its ICT tools. Three major goals requiring achievement have been identified: patient-centered recording and use of medical data for cooperative care, process-integrated decision support through current medical knowledge, comprehensive use of patient data for research and health care reporting.

  • Information society in Czech healthcare 'starting point' to prognosis for the year 2013 -- Zvarova J, et al. Int J Med Inf 2002 Nov 20;66(1-3):59-68
    A prognosis of how the information society in health care will look in 2013 must start from the current state of affairs at the given locality regarding healthcare management by public authorities including legislative, ICT technological levels and accessibility of professional knowledge in individual fields of medicine. It is presumed that after 10 years the influence of this 'starting point' will still persist and knowledge of the current state of affairs will be needed to positively but also negatively differentiate the prognosis for individual localities.

  • Information processing in healthcare at the start of the third Millennium: potential and limitations -- Haux R,et al. Methods Inf Med 2001 May;40(2):156-62
    Important aspects raised by the panelists and in the subsequent discussion were:
    1. The main goal of expanding information processing methodology (IPM) and information and communication technology (ICT) should be to further improve quality of care, while maintaining reasonable costs;
    2. With the support of modern IPM and ICT the boundaries between inpatient and outpatient care will fade away enabling a more efficient, patient-centered health care;
    3. Cooperation between health-care professionals will increase; there will be different ways of communication between them and with the patient, including modern ICT and the Internet;
    4. Society must be concerned with achieving equal opportunities in being informed about and in using new ICT;
    5. Misuse of data will remain a serious problem and can become an obstacle to progress.
  • A Clinical Information System Research Landscape -- Sittig DF, et al. The Permanente Journal Spring 2002/Vol. 6, No. 2; 62-68.
    This landscape enabled us to examine and potentially improve delivery of health care services from the perspective of its major constituents (ie, patients and their families, clinicians, processes for delivering care, organizations, patient populations) by using the information captured in CIS. We then identified aspects of the care delivery system which need to be addressed to improve the quality of care delivered: the care must be safe, effective, patient-centered, timely, efficient, and equitable. In addition to the static picture of this research landscape, we needed to portray the research process and how it relates to operational aspects of health care delivery.

  • A Clinical Information System Research Agenda for Kaiser Permanente -- Sittig DF, et al. The Permanente Journal Summer 2002/Vol. 6, No. 3. 41-44.
    We identified four CIS research priorities: clinical decision support systems, population-based care systems, personal health record systems, and establishment of a functional baseline against which future CIS enhancement can be measured. These research priorities should help guide researchers so they can focus their time, effort, and money on important questions that will inform KP and other health care providers about the use of CIS to improve health care.

  • Knowledge management to support performance-based medicine -- Stefanelli M. Methods Inf Med. 2002;41(1):36-43.
    The increasing pressure on Health Care Organizations (HCOs) to ensure efficiency and cost-effectiveness, balance the quality of care, and contain costs will drive them towards more effective management of medical knowledge derived from biomedical research. Knowledge management technology may provide effective methods and tools in speeding up the diffusion of innovative medical procedures. Reviews of the effectiveness of various methods of best practice dissemination show that the greatest impact is achieved when such knowledge is made accessible through the health information system at the moment it is required by care providers at their work sites. Thus, the great challenge for medical informatics is represented by the effective exploitation of the astonishing capabilities of new technologies to assure the conditions of knowledge management and organizational learning within HCOs.

  • Preparing for the Hospital of the Future: Working Towards the Virtual Hospital -- The evolution of clinical practice, with much more chronic and non-inpatient clinical services, has set the stage for the evolution of hospitals. At least four phases of this evolutionary process can be identified as follows: Devolution, Coordination/Communication, Integration and Virtualisation. The hospital evolves into an organisation including multiple campuses and services of diverse types (clinics, procedure centres, nursing centres of varying acuity, hospital in the home etc.) supported by a mix of facilities and services. These diverse health services are bound together by an information system serving both patient and organisation requirements. The bricks-and-mortar hospital is no longer the central focus of care. The "solid" remnants of the monolith are now merely supports for the information management system that has become the focus of care. This system, and the management of it, becomes the "virtual" hospital/health system.

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Dean F. Sittig, Ph.D.  11/15/03
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