The anatomy of a clinical information system

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Abstract
Medicine is critically dependent on accurate comprehensive data for good clinical management, audit, teaching, research, administration, financial control, general management, and statutory and legal needs.1 Computer technology offers solutions to the huge accumulations of clinical data in specialty and hospital medicine,2 yet it has not been fully exploited.3 The UK Audit Commission,4 US Institute of Medicine,5 and government initiatives6 have stressed the importance of clinical information systems centred on the individual patient. Most hospital computer systems are essentially for administration, and there have been relatively few successful clinical systems,7-9 with nephrology10 and intensive care medicine11 having progressed furthest. We describe a successful clinical system in nephrology based on an underlying flexible “generic” software package that can work in any specialty. The system is explained by reference to a general model of patient care. #### Summary points The proper foundation for healthcare computing should be clinical information systems based on the individual patient An underlying generic software package has been developed which can be adapted to any specialty Such a system can facilitate many aspects of clinical management, clinical administration, and general management With such systems, paperless operation is possible The care of each patient can be considered to be a control loop (fig 1),12 in which data from observations and investigations lead to decisions and actions designed to take care of a patient's problems and their consequences in a safe, effective, and legitimate manner. This loop occurs in all specialties and is the source of all the activities of a healthcare facility such as a hospital. Though complex, these activities can be set out as four concentric shells (see box and fig 2). The software package used (Proton) embodies generic techniques and structures for cost effective production of information systems for …