Researchon updating computer systems in hospitals

While Indiana’s Regenstrief Medical Record System (RMRS) was one of the first systems for both in-patient and outpatient settings [7], these early EMRs were rarely connected to the real-time data-intense environment of the ICU. Shubin and Weil are credited with introducing the computer to the ICU in 1966 for the purpose of automatically collecting vital signs from the bedside monitor [8].

By connecting an IBM 1710 computer through an analog-to-digital converter to bedside devices, they were able to collect arterial and venous pressure, heart rate, temperature, and urinary output.

This had actually been done before in the operating room, though not easily.

Using a mechanical contraption, Mc Kesson recorded tidal volumes, fraction of inspired oxygen, and blood pressure in 1934 [9].

Acquiring, synchronizing, integrating, and analyzing patient data remain frustratingly difficult because of incompatibilities among monitoring equipment, proprietary limitations from industry, and the absence of standard data formatting.

In this paper, we will review the history of computers in the intensive care unit along with commonly used monitoring and data acquisition systems, both those commercially available and those being developed for research purposes.

Providers must navigate through a jungle of monitors, screens, software applications, and often paper charts that provide supplemental patient data inherent in today’s cacophony of information management systems.

Data from patient monitors and medical devices, although available visually at the bedside, is challenging to acquire and store in digital format.

The computer-based Clinical Assessment, Research, and Education System (CARE) was a clinical decision support system developed to aid in the treatment of critically ill surgical patients.

The architecture also evolved from the locally contained model to the client/server model in which a workstation in the ICU (the client) interacted with a central computer housing patient data (the server) via a local area network (LAN).

Navigational tools became more user friendly though analytical capabilities remained limited [18].

Clinical information management systems are now common in most hospitals.

These systems have evolved along several parallel lines beginning, not surprisingly, in 1946 with the introduction of the Electronic Numerical Integrator and Computer (ENIAC), the first general-purpose computer (see Table 1). Five years later, IBM introduced the first commercially available computer, the Engineering Research Associates (ERA) 1103.

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