Most industries have plunged into data automation, but health care organizations have lagged in moving patients' medical records from paper to computers. In its first edition, this book presented a blueprint for introducing the computer-based patient record (CPR). The revised edition adds new information to the original book. One section describes recent developments, including the creation of a computer-based patient record institute. An international chapter highlights what is new in this still-emerging technology. An expert committee explores the potential of machine-readable CPRs to improve diagnostic and care decisions, provide a database for policymaking, and much more, addressing these key questions:

• Who uses patient records?
• What technology is available and what further research is necessary to meet users' needs?
• What should government, medical organizations, and others do to make the transition to CPRs? The volume also explores such issues as privacy and confidentiality, costs, the need for training, legal barriers to CPRs, and other key topics.

Contents

• Committee on Improving the Patient Record in Response to Increasing Functional Requirements and Technological Advances
• Preface—Revised Edition
• Preface—Original Edition
• Acknowledgments—Revised Edition
• Acknowledgements—Original Edition
• Commentary: A Progress Report on Computer-Based Patient Records in the United States
• Commentary: A Progress Report on Computer-Based Patient Records in Europe
  • The Current State of CPRs in Europe
  • CPR Systems in Primary Care
  • CPR Systems in Hospitals
  • CPR Systems for Shared Care
  • Use of CPR Data
  • Integration of Protocols with CPR Systems
  • Addressing Barriers
  • Conclusion
  • References
• Summary
  • User Needs and System Requirements
  • Computer-Based Patient Record Technologies
  • Nontechnological Barriers
  • Recommendations
• 1. Introduction
  • The Study
  • Report Organization
  • The Patient Record
  • Information Management Challenges
  • Information Management Opportunities
  • Beyond Technology
  • Why Now?
  • References
• 2. The Computer-Based Patient Record: Meeting Health Care Needs
  • Defining Health Care Needs
  • Translating Customer Needs Into System Requirements
  • The Future Patient Record
  • References
• 3. Computer-Based Patient Record Technologies
  • Technological Building Blocks for CPR Systems
  • Experience with CPR Systems
  • An Overview of CPR Systems
  • Clinician Interaction and Resistance
  • Technological Barriers
  • Summary
  • References
  • Appendix: the Computer-based Patient Record System Vendor Survey
• 4. The Road to CPR Implementation
  • Development and Diffusion Factors
  • Elements of an Implementation Strategy
  • Summary
  • References
  • Appendix: Maternal and Child Health Care and Computer-Based Patient Records
• 5. Improving Patient Records: Conclusions and Recommendations
  • Conclusions
  • Recommendations
  • Summary
• Appendix A Subcommittees
• Appendix B Legal Aspects of Computer-based Patient Records and Record Systems

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.