Clinical Information
Systems: Achieving the Vision
Brian Raymond and Cynthia Dold
Kaiser Permanente Institute for Health Policy,
Kaiser Foundation Health Plan, Inc.,
Oakland, CA.
Clinical information systems (CIS)
and other information management tools hold the promise of improving the
quality and safety of patient care and increasing the efficiency of health
care personnel. However, the health care industry lags behind other sectors
in information technology investment and, with few exceptions, has not fully
benefited from the information revolution.
The practice of medicine, which largely uses paper-based records and is heavily
dependent on unaided recall, is ripe for change. The limitations of the 20th
century health care system are such that the old medical care paradigm is
less viable and the emergence of a new way of practicing medicine is almost
inevitable. Evidence-based medicine is the foundation for an emerging paradigm
in medicine that calls for new tools to enable improved quality and outcomes.
Furthermore, a variety of system enhancements can prevent many of the medical
errors and adverse events that currently plague our health care delivery
system. Clinical information systems can be a bridge to this new paradigm
by providing the fastest route to evidence-based medical knowledge coupled
with more complete and accurate patient data and diagnostic and treatment
information.
The growing body of evidence of the value of CIS shows that clinical applications
such as computerized reminders, automated order entry systems, and decision
support tools can enable significant improvement in preventive health
services, disease management, and patient safety. The evidence also suggests
that clinical information systems provide practitioners with timely and comprehensive
information, which leads to improved care. Health promotion and personalized
care are also major tenets of the clinical information
system value proposition.
A variety of barriers stand between health care providers and the implementation
of clinical information systems. Among the most significant of these are
the high capital and operating costs, competing priorities for limited resources,
cultural issues, and the difficulty of defining and capturing a return on
these investments. A select few larger, integrated delivery systems in the
U.S. have uniquely positioned themselves to take advantage of CIS and have
demonstrated the value of these systems in care delivery.
Progress toward broader use of clinical information technology in health
care will not occur in the absence of sound public policy. To this end, the
Kaiser Permanente Institute for Health Policy set forth the following policy
recommendations:
- Recommendation 1:
The federal government should provide leadership to encourage development
of a standard clinical vocabulary, standards for the exchange of clinical
information, and other standards for interoperability as they emerge.
- Recommendation 2:
State and federal privacy policy should avoid establishing barriers to the
legitimate development and use of clinical information technology. Clinical
Information Systems: Achieving the Vision
- Recommendation 3:
The cost of health information technologies should be shared among those
who benefit from them. Public investment is needed to encourage the adoption
of these important technologies.
- Recommendation 4:
Research and development focused on implementation and effective use of health
information technologies should be encouraged and supported.
© Kaiser Permanente Health Policy Institute, 2002