Global Challenges and Opportunities for Clinical Informatics

HIMSS Clinical Informatics Insights

In every country critical care support for potentially reversible acute illness or injury is one of the most cost-effective fields of medicine. However, incomplete knowledge and delayed, error prone care delivery greatly minimizes its impact worldwide. Advances in information technology and computer literacy provided unprecedented opportunity to facilitate safe and effective care delivery across the world and improve outcomes for any health systems sickest and most expensive patients.

Unfortunately, the implementation of the first generation of clinical information systems in the emergency and critical care settings largely made things worse: causing information overload, disrupting workflow, and increasing false alarms. Worse of all, physicians and nurses with limited computer literacy spend most of their time at the computer workstations battling unfriendly programs so there is more limited time spent at the bedside. Disparate databases, lack of standardized common data elements and barriers to data integration made secondary data uses all but impossible in most hospitals.

On the bright site, starting electronic systems in an international hospital setting with variable resources, where the potential benefit of critical care is the largest, provides an opportunity to get things right from the outset. Lessons learned over the past decade have greatly informed new global initiatives. Although most top down approaches for “meaningful use” has had limited impact, exciting collaborations between experts in clinical medicine and information technology are rapidly developing in many parts of the world. The table below lists both the challenges and opportunities for clinical informatics in the emergency and critical care setting.


Global challenges and opportunities in clinical informatics pertaining to acute illness and injury



Information overload and alarm fatigue

Dashboards, filters and smart alarms

Complex, time sensitive workflows

Ambient intelligence and ergonomics (devices and systems)

Lack of pertinent data in the standardized electronic format

Mobile technologies combining decision support with structured data entry (common data elements)

Lack of competence/prolonged expensive training

Point of care decision support, remote simulation and tele-consultation

Lack of bedside presence (everyone is on computer)

Incentives to minimize unnecessary paperwork, cognitive ergonomics

Uncertainty about individual prognosis

Computer-based modeling and forecasting

Incomplete understanding of underlying mechanisms

Computer-based modeling to identify testable hypotheses

Lack of evidence-base and challenges with clinical trials

Observational comparative effectiveness research in clinical databases


Understandably, these are exciting times for clinicians, researchers and the industry partners on a quest to improve care and outcomes of patients facing life-threatening illness or injury.

About the Contributor
Dr Gajic’s main research interest is clinical management of critical illness and injury with particular focus on translational research, health care delivery and informatics. He is a director-elect of the US Critical Illness and Injury Trials group and a principal investigator on a CMS Innovation Project, ProCESs AWARE (Patient Centered Cloud-based Electronic System: Ambient Warning and Response Evaluation).