Trends of strategic importance for the future information landscape in the hospital.

Hospitals are complex enterprises with, at the time being, evolving organizational structures. In the 80s innovative system concepts for the computer support of such complex organizations were developed, based on a controlled distribution of the components of multi-functional information systems (IS). More recently several R&D initiatives promoted these issues in general and for hospital information and communication systems (HICS) in particular. Three leading strategic ideas have in the meantime attained fundamental importance and will be considered in more detail: distribution, integration, and evolution. Strong interdependencies exist however between those three concepts, mainly expressed by the notions of interoperability and coupling of system components. In the context of a distributed IS, the notion of integration has to be extended since the centralization of all dp resources is replaced by a cooperative system concept with centralized control functions for information of hospital-wide interest, based on global models for data and processes, and distributed dp resources with a powerful central component, which is especially true for most HICS. In view of the broad scope of requirements, it is not feasible to construct these comprehensive multi-functional systems as closed and complete products. Therefore a concept of evolutionary system development is indispensable. Finally, the overall functionality of commercially available software products for integrated HICS is analyzed. With regard to the present German market for HICS of the new generation, the patient administration and hospital management functions of the care system are covered rather well; the medical/clinical functions however are not at all complete.