Neonatal Informatics—Dream of a Paperless NICU

Attempts to “computerize neonatal intensive care units (NICUs)” emerged simultaneously with the development of neonatology, beginning in the 1960s. The academic underpinnings to inform prior computerization attempts awaited the birth of the newly emerging fields contained in “health-care informatics.” Decades of attempts to computerize the NICU environment have produced local, partial successes, including successful installation of computerized monitors that report trends, buying or developing systems that produce letters from coded fact sheets, and development of many focused computer utilities to perform care task-related calculations. Enormous political pressures are urging health care to “get computerized.” Most hospitals are in the process of installing (or reinstalling) “hospital information systems (HISs).” Such efforts have exposed significant problems and limitations of current HIS systems for critical care situations. Extending office-designed computer systems safely and effectively into intensive care units and other real-time hospital venues has presented substantial difficulties. In late 2008, most NICUs still integrate multisource clinical data at the bedside by charting each hour with pen in small boxes on folding paper flowsheets, a slow, error-prone, and imprecise method for tracking unstable situations. To improve minute-by-minute management of unstable patients, all intensivists need automatic, real-time integration of machine, laboratory, and bedside observational data, presented in medically comprehensive, user-definable formats. Clinicians need reflex response speed (14 msec) in every clinical computer utility used in their “workflow.” Similar sets of unique human computer/interactions of teams working in safety critical situations such as nuclear power plants, battleships, and airplane cockpits have been studied extensively by scientists known as “human factors engineers.” Human factors situations rarely have been studied in hospitals, and not at all for NICUs. Overall, this neonatal informatics series defines the current state of the “paperless” effort. Part 1 provides a historic and situational overview of current problems in optimizing hospital computer systems for critical clinicians, including communication, NICU computerization history, and an introduction to systems analysis, which is a key exercise for planning future NICU computer systems.