Electronic Patient Information -- Pioneers and MuchMore. A vision, lessons learned, and challenges.

Objectives: This paper must fulfill three different tasks: First, to introduce the topic "Electronic Patient Information -- Pioneers and MuchMore", second, to introduce the invited authors of the symposium, and third, to serve as the author's academic farewell lecture as professor emeritus.

Results: The electronic patient record, with all its different kinds of patient information, can be structured in many ways. Here, an historical approach is presented with a primary focus on the development of an information system for in- and outpatients in Germany, especially in Frankfurt, but also in comparison with US systems. The "Stone Age" and "Bronze Age" of patient-related computer applications started with expensive and insufficient hardware, but some years later, the first systems for patient documentation, text generation, and data acquisition could be implemented. The "iron age" and "golden age" yielded until the mid-1970s, e.g. in Oakland, Boston, Salt Lake City, and Frankfurt, quite successful Hospital Information Systems with some special emphasis on natural language processing. The following dark years were filled primarily with administrative systems, but beginning in the early 1980s, an era of enlightenment started, e.g. with rather inexpensive and easy to use PC application, broadly distributed MUMPS systems, and improved thesaurus-based text analysis. Especially in modern times, the medical text processing and classifying has been extended and successfully applied.

Conclusions: Somewhat in contrast to other approaches, in the future the use of medical linguistics for the development of a successful electronic patient record should be better supported. Electronic patient information should be available wherever and whenever needed. For this, intelligent and automated reporting and controlled data exchange is necessary. The computer should do all classification, coding, and administrative work, and the physician should get all relevant information necessary for decision making.