van der Lei J
Department of Medical Informatics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Methods Inf Med. 2002;41(1):51-4.
To discuss the possible contribution of electronic patient records in closing the loop among clinical practice, research and education.
Applying Information and Communication Technology (ICT) to a given medical domain is not merely adding a new technique. When introduced into an environment, ICT will initially often emulate or resemble the already existing processes. When workers and researchers in that domain begin to appreciate the potential of ICT, this initial stage is followed by more fundamental changes in that domain that take advantage of the potential of ICT. To understand the scope of the potential changes enabled by electronic records, three principle changes need to be understood. First, data recorded in computer memories can be readily retrieved and re-used for a variety of purposes. Second, once data are available in computer memories, the data can be transported easily. Third, as physicians (and patients) are using computers to record medical data, the same electronic record can be used to introduce other computer programs that interact with the user. New usage of data, however, generates additional requirements. Thus the experience in developing decision support systems and analyzing observational databases feeds back into the requirements for electronic medical records. Each patient-physician encounter, each investigation, each laboratory test, and each treatment in medical practice constitutes, in principle, an experiment. Ideally, we learn from each experiment. Electronic medical records will facilitate research that relies on data recorded in routine medical practice. The potential and challenge, however, of Medical Informatics lies in its ability to close the loop among clinical practice, research, and education.
探讨电子病历在弥合临床实践、研究和教育之间的循环方面可能做出的贡献。
将信息通信技术（ICT）应用于特定医学领域不仅仅是添加一项新技术。当引入一个环境时，ICT最初通常会模仿或类似于已有的流程。当该领域的工作人员和研究人员开始认识到ICT的潜力时，这一初始阶段之后该领域会发生更根本性的变化，以利用ICT的潜力。为了理解电子记录所带来的潜在变化的范围，需要理解三个主要变化。首先，记录在计算机存储器中的数据可以很容易地被检索并重新用于各种目的。其次，一旦数据存在于计算机存储器中，就可以轻松传输。第三，由于医生（和患者）使用计算机记录医疗数据，同一个电子记录可用于引入与用户交互的其他计算机程序。然而，数据的新用途会产生额外的要求。因此，开发决策支持系统和分析观察性数据库的经验会反馈到对电子病历的要求中。在医疗实践中，每次医患接触、每项检查、每项实验室测试和每次治疗原则上都构成一个实验。理想情况下，我们能从每个实验中学习。电子病历将促进依赖于常规医疗实践中记录的数据的研究。然而，医学信息学的潜力和挑战在于其弥合临床实践、研究和教育之间循环的能力。
