Hospital information systems: perspectives on problems and prospects, 1979 and 2002

PURPOSE To assess progress made in hospital information systems (HIS) since 1979, when the forerunner of the International Medical Informatics Association Working Group on HIS first met. METHODS A review of the recommendations made in 1979 identified core concerns, which were analyzed in light of the state of the art in 2002. RESULTS Despite significant changes over the years, the underlying concerns identified in 1979 are still valid today. In 2002 as in 1979, HIS must be integrated into the hospital's organizational structure; financial and economic benefits depend upon using technology as an enabler of improved clinical outcomes; and education and training remain critical to the successful use of technology solutions. The tools available for addressing these concerns have changed enormously. Where there were dumb terminals, there are the World Wide Web and handheld devices. As a result, we are raising our expectations and changing the terms of our discussions. Today the focus is shifting to patient safety, decision support, and evidence-based practice; the concerns voiced in 1979 have become medical informatics cornerstones. New tools and new approaches now available can improve the quality of care. Using them appropriately requires careful planning and education for patients as well as healthcare professionals.