Outpatient Information Systems (OISs) for Ambulatory Care

Abstract

Of the relatively few outpatient information systems (OISs) operational in the United States in the 1960s, most were in ambulatory clinics that shared time on mainframe computers with affi liated hospitals. In the 1970s some larger physician practices launched standalone OISs on minicomputers. With the advent of microcomputers in the 1980s, OISs began to diffuse rapidly, some as federally funded pilots. By the end of the 1980s, about 80 % of physicians had some type of computer in their offi ces, primarily for administrative and business functions; computer-based patient records and other OIS clinical applications were still infrequently used. When admitting a patient to the hospital, few physicians could transfer data from their OIS to the hospital information system. For the most part, lack of standardization made the interchange of data diffi cult or impossible. However, three OISs achieved notable success in the 1970s and 1980s. Each was developed in an academic environment and led by a committed physician; each developed a "chartless" record, continuously updated and stored in the computer; two of the three had linkages to large affi liated hospitals. Yet they were the exception. Few evaluations of OISs were convincing as to their benefi ts. Low physician adoption of OISs suggested computer-based records were not considered more effi cient for offi ce practice than paper-based records. Expectations for the 1990s were that OISs would change to support electronic claims reporting and quality of care monitoring. In the 2010s, federal funding became available for physicians who purchased electronic health record systems complying with "Meaningful Use." Keywords