title: Clinical Information Systems - From Yesterday to Tomorrow.
abstract: OBJECTIVE
  To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years.
  
  
  METHODS
  Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author's personal experience with developing the HELP system were also used.
  
  
  RESULTS
  There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes.
  
  
  CONCLUSIONS
  Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.
authors.affiliation: Reed M. Gardner, PhD, Professor Emeritus, Department of Biomedical Informatics, University of Utah, 1745 Cornell Circle (Home Address), Salt Lake City, UT 84108, Tel: +1 801 581 1164, Cell: +1 801 455 8207, E-mail: reed.gardner@hsc.utah.edu.
authors.forename: R M
authors.initials: RM
authors.lastname: Gardner
mesh_terms: D020000:Decision Support Systems, Clinical / Q000266:history / Q000639:trends*; D057286:Electronic Health Records / Q000706:statistics & numerical data / Q000639:trends; D005544:Forecasting; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007256:Information Systems / Q000639:trends; D016347:Medical Records Systems, Computerized / Q000266:history / Q000639:trends*; D061214:Patient Safety
keywords: Clinical informatics; computer assisted; decision making; electronic health records; patient safety