Information management & decision support systems in the intensive care unit.

Overview

Management of the vast array and sheer volume of clinical data generated during the care of the critically ill patient is a formidable task. Not only must the data be acquired accurately, but it must be retrievable readily and in an interpretable form. Such characteristics are essential features, but the mere uncritical compilation of biomedical data barely takes advantage of the enormous computing power that is available at the bedside. A complete medical informatics package can assist the caregiver with clinical decision making, suggest or even carry out changes in management, and provide continuous, always vigilant surveillance for both dangerous alterations in physiology or ill-advised orders. For optimal implementation, knowledge of the origin, synthesis, and utility of clinical information is essential. A successful implementation using the skills of physicians, nurses, biomedical engineers, computer scientists, and hospital administrators must be collaborative. The characteristics of a clinical information system were defined recently by the Institute of Medicine of the National Academy of Sciences (Table 1). However, even the ideal system, implemented and administered by a harmonious and committed team, will not ensure clinical acceptance. The issue of accessibility can become paramount. If the system is not responsive to the needs of the occasional user, a great deal of expensive hardware will not be used to its full capability.