Critical care computing. Past, present, and future.

With rapidly increasing processing power, networks, and bandwidth, we have ever more powerful tools for ICU computing. The challenge is to use these tools to build on the work of the Innovators and Early Adopters, who pioneered the first three generations of systems, and extend computing to the Majority, who still rely on paper. What is needed is compelling evidence that these systems reduce cost and improve quality. The experience of other industries suggests that we need to address fundamental issues, such as clinical organization, roles, behavior, and incentives, before we will be able to prove the benefits of computing technology. When these preconditions are met, the promise of computing will be realized, perhaps with the upcoming fourth-generation systems. ICU computing can then finally cross the chasm and become the standard of care.