The hospital of the 21st century will be paper-free or it simply will not be at all. As innovative information and communications technologies (ICT) are gradually entering the health care sector, typical one-liners of this kind enjoy a growing popularity among IT experts. Yet, clearly established trends in hospital data processing are difficult to pin down. Client/server architectures with access to the Internet show promising perspectives but PC solutions for health care institutions still remain expensive while none are really hacker-proof. The implementation of network computers or terminals perhaps may constitute a useful alternative. At the Medica 98 Fair, held in Düsseldorf last November, several IT providers demonstrated current and future solutions for hospital information management and telemedicine applications as well.
If sound prognoses on a specific global IT concept for the hospital of tomorrow are practically impossible to give, it is equally difficult to express firm opinions on the smooth integration of the existing medical information systems. Only the multiple installation of networked PC workstations in an open client/server architecture is commonly regarded as a viable application. The introduction of the PC in the hospital environment immediately raises the issues of security, privacy and data protection. Hospital managers are constantly faced with the implicit danger of configuration data being deleted by accident.
In addition, alien software such as games, screen savers, and chance viruses are hard to banish from the system. In turn, the installation of commercial "home" software can cause the standardized PCs to block in their tracks. Malicious abuse of medical data by means of illegal trapping or the exportation of patient records constitutes another severe but all too common problem with regard to clinical information protection. Not a single security programme is foolproof, no single socket is 100% trustworthy.
Remains the question whether the implementation of a full-scale network of PC workstations across the health care institution constitutes an affordable option. Experts estimate the costs for a well-equipped hospital information system in a university clinic at about thirty million marks. The annual cost for a 400-bed health care facility with a staff of 450 persons and a turnover of 80 million marks per year, amounts to between 2.4 and 4 million marks every year for the mere running and update of the information processing.
About three years ago, the network computer was introduced to the hospital as an alternative solution. In fact, this system tool can be considered as a so-called bonsai computer, accessing its essential software, programmes and data from the clinic's self-established Intranet. In the meanwhile, the initial enthusiasm somewhat died away, since this type of "lean" PCs seems not quite as suitable as expected for the data processing in hospital infrastructures. Installation remains expensive and the systems are still susceptible to hacker assaults.
When it comes to modern hospital data processing, the IT experts swear by network terminals or network computers as the only configurations which are economically viable and capable of meeting the strong requirements with regard to data protection and manipulation security. Some hospitals slowly begin to explore the market to invest in advanced information processing but many still continue to work with hard copy data. In Germany, no more than two dozen health care facilities have now installed one of the eight electronic patient file management and storage systems which are currently available.
A lot of work still remains to be done in the medical sector to make hospitals more familiar with digitization. Data processing penetration is low and often applied at a basic, almost rudimentary level. Many hospitals in Germany are heading right for hands-on digital confrontation.