Clinical Information Systems

The components of the informatics infrastructure are linked through clinical information systems that provide the mechanism for sharing data collected from the various systems, reducing or eliminating redundancies in data collection/documentation and increasing the reliability and comprehensiveness of patient data available to the clinician. Within the context of a comprehensive integrated system, clinical information systems can support patient safety and quality management through the use of decision support tools for the prevention and detection of adverse events and near misses.

Ideally, the NHII will rely on the EHR as the central integrating component for data acquisition, analysis, and storage. Key capabilities of an EHR system include core health information, results management, order management, decision support, communication, patient support, and reporting (Institute of Medicine, 2003). Technical issues related to the EHR structure, function, and data standards are being resolved by NCVHS and by private-sector standards development organizations (e.g., Health Level Seven).

Decision support systems are the key tools enabling clinicians to access health care knowledge at the point of care as they progress through the care continuum. For example, encoded medical knowledge about the meaning and significance of changing laboratory test results would allow a system to provide alerts, an active function, in addition to the passive data retrieval function (Institute of Medicine, 1997). Methodologies for decision support can take many forms—reminders and alerts, embedded controls, decision assistance, and/or risk prediction (Institute of Medicine, 1992)—all of which have significant potential to improve patient safety. CDSSs can be only as effective as the strength of the underlying evidence base (Sim et al., 2001). Therefore, CDSSs must be designed to be evidence adaptive such that the clinical knowledge base is derived from and continually reflects the most up-to-date evidence from the research literature and practice-based resources (Sim et al., 2001).

IMPLEMENTING THE SYSTEMS

The IOM–Health Level Seven Demonstration Project: Where Are We Now?

The committee participated in the Health Level Seven (HL7) Interoperability Demonstration project at the Annual Conference of the Health Information Management Systems Society (HIMSS), held February 10–13,



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