Making the boundaries clearer: revisiting information systems with fading boundaries.
PURPOSE: To address issues of importance in 1994 and what has happened in those issues. METHODS: A number of questions and issues will be examined. Were we right in our focus at that time and what did we miss? What has happened that perhaps changed our perspectives and philosophies? Has the need changed? Is the model of fading boundaries a correct one, and how far have we gone in realizing a communication system in dealing with those boundaries? What progress have we made internationally on these issues? How are we working internationally to solve these problems? RESULTS: The fifth working conference relating to hospital information systems (HIS) was held in Durham, North Carolina in August 1994. The Institute of Medicine publication The Computer-based Patient Record: An Essential Technology for Health Care had been published in 1991 and had begun influencing thinking and direction for clinical information systems. The difference between and relationship of HIS and Computer-based Patients Records was the topic of much discussion and debate. The 1994 conference strongly recognized the need for standards specifically for data exchange, unique patient identifier, data definitions and common clinical data sets and for clinical terminology. Interconnectivity and interoperability were identified as separate but related problems to be solved. Technology was not considered to be a barrier, and projections for bandwidth to meet data dissemination requirements were favorable. In the 7 years after the Durham conference, many things have changed dramatically. Progress has been made in a number of areas, and some of the projections have been realized. However, it is surprising to note what areas still remain problems, particularly noting what problems have been worked on without success and what problems have not even been addressed. It is interesting to speculate that if the Durham conference was repeated today, would it be accepted as a current event?
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