Electronic Clinical Records

Function

Today's healthcare industry professionals expect electronic clinical records to provide the following: patient information such as demographic and insurance data; patient health data such as allergies, problem lists, history and physical data, advance directives, operative and other procedural summaries; access and management of test results, including laboratory, microbiology, pathology, and other examinations; patient orders; patient notes and clinician summaries; clinical decision support specific to patient parameters; medication lists; radiology and other imaged studies; diagnoses; consult summaries; patient-specific scanned documents, pictures, and sounds; chronic disease management and pathways/reminders; and access to knowledge sources.

History

While a few large hospitals first began using computers in the 1950s to support financial, billing, and administrative functions, it was not until the 1960s that EMRs were viewed as a possibility. The idea of using computers to record patient treatments was part of President Kennedy's vision for the future of the nation. Early in his term of office, President Kennedy proclaimed that the United States would land a man on the moon by the end of the decade of the 1960s. This ultimately led to increased federal funding of NASA and the development of the nation's space program.

The Lockheed Corporation, one of the major beneficiaries of government funding for space research and exploration, decided that it was in the public's interest to use the recently developed space program technology for the benefit of all citizens of [Page 340]the nation. Lockheed decided to develop a computer application that would manage the patient care delivery and clinical documentation processes in hospitals. In the late 1960s, Lockheed began the project at El Camino Hospital, a community hospital in Mountain View, California. By 1973, the first patient care unit was “live” on a computer system, and the majority of the unit's clinical processes, nursing observations and interventions, patient orders, and test results were documented and automated in the first electronic clinical record system. This live unit was tweaked and debugged during the next year, before the system was expanded to other patient care units in the hospital. By 1976, the majority of El Camino Hospital was live on the first patient care system, using a large IBM mainframe as its host computer.

By the mid-1970s, as word of the El Camino project spread, other development efforts began to take shape. These efforts were led by a number of companies, such as HBO (now part of McKesson Corporation), McDonnell-Douglas (the aircraft manufacturer whose healthcare information technology business is also now part of McKesson), ISM (product name of PCS/ADS), and SMS (now part of Siemens), among several others. However, the majority of these developments resulted in a number of limited clinical systems that only communicated orders from patient care units to other ancillary departments such as laboratory or radiology. These systems were sold, but in many cases, they were not expanded into functional CPR systems.

...