Hurst (1975:xii) revealed that many of the systems planned or developed during the 1960s were "extinct—blunt testimony to the difficulties of implementing computer-based information systems for health care delivery. … Medical computer applications which meet operational criteria are rare except for routine business applications. … Other than in developmental projects, computerized medical records are abstracts of more complete records maintained in hard copy form."
With the advent of less costly mini- and microcomputers, clinical information system development flourished during the 1970s and 1980s. The advances made during these years focused primarily on departmental systems (known today as subsystems) for such areas as the clinical laboratory, radiology, electrocardiology, and the pharmacy. One reason for this flurry of development was that departmental systems were easier and less risky to develop than comprehensive systems covering patient care management.
The 1970s and 1980s also saw the development of systems for clinical decision support (Warner et al., 1972; Shortliffe, 1987). To perform their sophisticated functions, these complex systems require that at least a subset of the CPR be available as input—that is, in machine-readable form. Once the use of CPRs becomes more widespread and more and more patient data are captured, these systems should become increasingly valuable to clinicians.
Virtually all of the current clinical information systems that might qualify as CPR systems have evolved from a strong academic medical center's teaching hospital or clinic records. Examples of this phenomenon include the COSTAR6 (Computer Stored Ambulatory Record; Barnett, 1984) system, which is used by several institutions, including the Harvard Community Health Plan; a system used by the Latter-Day Saints Hospital in Salt Lake City, Utah, known as Health Evaluation through Logical Processing (HELP),7 which was developed by faculty at the University of Utah (Warner et al., 1972; Pryor et al., 1983, 1984); the TMR (The Medical Record) system at Duke University Medical Center (Stead and Hammond, 1988); and the THERESA system at Grady Memorial Hospital, the primary teaching hospital for Emory University's medical school (Walker, 1989).
With few exceptions, software developed in an academic setting is not generally considered to be particularly robust or of an "industrial or commercial grade"; consequently, some experts have been skeptical about the functionality of these and other clinical information systems. Nevertheless, many of these systems have proved their usefulness and viability in supporting the actual delivery of health care in real-world settings. Attributes