History and trends in clinical information systems in the United States

Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics, Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current adv ances and issues in managing clinical information, and future trends and is sues. Methods: Literature review and analysis. Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-s ervice to managed care required a change in the design of clinical informat ion systems toward more patient-centered systems that span the care continu um, such as the computer-based patient record (CPR). Current difficulties w ith CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integr ation and increased use of the Internet for health information will shape t he future of clinical information systems.