Biomedical Informatics 4th Edition by Edward Shortliffe, James Cimino

Exercise 2

Sect. 1.1 . After scientists had developed the first digital computers in the 1940s, society was told that these new machines would soon be serving routinely as memory devices, assisting with calculations and with information retrieval. Within the next decade, physicians and other health professionals had begun to hear about the dramatic effects that such technology would have on clinical practice. More than six decades of remarkable progress in computing have followed those early predictions, and many of the original prophesies have come to pass. Stories regarding the "information revolution" and "big data" fill our newspapers and popular magazines, and today's children show an uncanny ability to make use of computers (including their increasingly mobile versions) as routine tools for study and entertainment. Similarly, clinical workstations have been available on hospital wards and in outpatient offices for years, and are being gradually supplanted by mobile devices with wireless connectivity. Yet many observers cite the health care system as being slow to understand information technology, slow to exploit it for its unique practical and strategic functionalities, slow to incorporate it effectively into the work environment, and slow to understand its strategic importance and its resulting need for investment and commitment. Nonetheless, the enormous technological advances of the last three decades-personal computers and graphical interfaces, new methods for human-computer interaction, innovations in mass storage of data (both locally and in the "cloud"), mobile devices, personal health monitoring devices and tools, the Internet, wireless communications, social media, and more-have all combined to make the routine use of computers by all health workers and biomedical scientists inevitable. A new world is already with us, but its greatest influence is yet to come. This book will teach you both about our present resources and accomplishments and about what you can expect in the years ahead. When one considers the penetration of computers and communication into our daily lives today, it is remarkable that the first personal computers were introduced as recently as the late 1970s; local area networking has been available only since ~1980; the World Wide Web dates only to the early 1990s; and smart phones, social networking, and wireless communication are even more recent. This dizzying rate of change, combined with equally pervasive and revolutionary changes in almost all international health care systems, makes it difficult for public-health planners and health-institutional managers to try to deal with both issues at once. Yet many observers now believe that the two topics are inextricably related and that planning for the new health care environments of the coming decades requires a deep understanding of the role that information technology is likely to play in those environments. What might that future hold for the typical practicing clinician? As we shall discuss in detail in Chap. 12, no applied clinical computing topic is gaining more attention currently than is the issue of electronic health records (EHRs). Health care organizations have recognized that they do not have systems in place that effectively allow them to answer questions that are crucially important for strategic planning, for their better understanding of how they compare with other provider groups in their local or regional competitive environment, and for reporting to regulatory agencies. In the past, administrative and financial data were the major elements required for such planning, but comprehensive clinical data are now also important for institutional selfanalysis and strategic planning. Furthermore, the inefficiencies and frustrations associated with the use of paper-based medical records are now well accepted ( Dick and Steen 1991 (Revised 1997) ), especially when inadequate access to clinical information is one of the principal barriers that clinicians encounter when trying to increase their efficiency in order to meet productivity goals for their practices
-Reread the future vision presented in Sect. 1.1 . Describe the characteristics of an integrated environment for managing clinical information. Discuss two ways in which such a system could change clinical practice.