The Computer-Based Patient Record An Essential Technology for Health Care, Revised Edition (1997) / Chapter Skim
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A Progress Report on Computer-Based Patient Records in the Unites States
A Progress Report on Computer-Based Patient Records in the Unites States
Pages 1-20
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The current environment in which health care is practiced and the information technology available to its practitioners are significantly different from that which existed when the study was completed in 1991. Changes in the health care environment produced fundamental shifts in the delivery of health care, favoring outpatient care over inpatient care, primary care over specialty care, and guidelines-driven care over autonomous decisionmaking.
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Consequently, vendors of information system products for hospitals find that there is a steep learning curve to understanding the information needs of physicians in the ambulatory care setting. Deliberate analysis of the information needs and work flow requirements in ambulatory care will help system developers design information systems that increase the efficiency and effectiveness of clinical practice throughout the continuum.
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NCQA advised health plans to "move to fully implement the information framework, including the automated patient record" in order to meet the clinical reporting requirements of forthcoming regulations (NCQA, 1997~. As outcomes reporting requirements become more sophisticated and deal with complex, multifaceted diseases, it will be essential to have electronic access to the record and tools to efficiently analyze practice patterns and patient outcomes.
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To the extent that health care becomes dependent on access to computer networks, however, policymakers need to pay special attention to the needs of the medically underserved population to ensure that lack of network access does not further impede their access to care. Connectivity is not the only requirement for transmitting patient data to remote sites.
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These advantages are particularly important for health care applications, and most health care organizations are exploring the use of Intranets as a component of their information strategy. Network-Centric Computing Industry is at the cusp of another major change network-centric computing.
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Although the path is not necessarily sequential, five hallmarks of this transformation are enumerated below: 1. Integrated view of patient data, Access to knowledge resources, Physician order entry and clinician data entry, 4.
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Most CPR system vendors offer products that combine data from various sources and present an integrated view to clinicians. Access to Knowledge Resources Providers often need other information in addition to patient data and their own personal knowledge (Covell et al., 1985~.
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Of the seven institutions that have been recognized as part of the Computer-based Patient Record Institute Davies CPR Recognition Program (described below) , four are academic medical centers and one is the Department of Veterans Affairs.
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Due to AHCPR' s role in developing scientifically based clinical guidelines, it has long recognized the importance of standard data definitions and capturing clinical data in structured form. AHCPR has also played an active role in facilitating standards development.
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One focal point for accelerating the development of the infrastructure for CPR systems (e.g., confidentiality policies, standards, evaluation criteria) in the private sector has been the Computer-based Patient Records Institute (CPRI)
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CPRI described a CPR as "electronically stored information about an individual' s lifetime health status and health care." It replaces the paper medical record as the primary record of care, meeting all clinical, legal, and administrative requirements. A CPR system provides reminders and alerts, linkages with knowledge sources for decision support, and data for outcomes research and improved management of health care delivery.
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Although user acceptance was a major barrier in the past, more and more users are demanding that organizations implement computer-based means for accessing and managing patient data. This is not to say that the cultural and organizational challenges associated with major change are not substantial barriers to overcome, but the users' awareness of the potential benefits will become an increasing catalyst for change.
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Public Law 104-191 (The Insurance Portability and Accountability Act of 1996) calls for the secretary of Health and Human Services "to adopt standards for unique health identifiers, confidentiality policies, and terminology." To build support for addressing these pivotal issues, in November 1996, CPRI convened a national Summit of over 80 senior executives representing health care providers, health systems, government agencies, information systems vendors, businesses, regulators, and quality assurance professionals.
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CPRI has produced position papers on user authentication and access to patient data and provided substantive guidelines on security policies, security education programs, job descriptions for information security managers, model confidentiality policies, and security functionality requirements for CPR systems (CPRI, 1995a,b, 1996b,d)
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This balance must be carefully crafted in the enabling legislation and policy standards, and enforceable through system security functions. In addition to clinicians, researchers, quality assessment professionals, and health care managers need access to aggregate data to continuously improve health and the delivery of health care.
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The Nicholas E Davies Annual CPR Recognition Symposia provide recognition for organizations demonstrating exemplary measurable impact of CPR systems on health care at their organizations (CPRI,1995c,1996c, 1997~.
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Only by capturing primary clinical data from health care providers in a way that they can be applied to health care decisions for individuals and to policy decisions for populations can the United States achieve its goal of providing high-quality, affordable health care for all. A computer-based patient record is essential to accomplishing that goal.
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Journal of the American Medical Informatics Association ASTM Committee E-31 on Healthcare Informatics. Group of standards available from ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959.
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Journal of the American Medical Informatics Association 3:281-287. IEEE (Institute of Electrical and Electronics Engineers)
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Journal of the American Medical Informatics Association 2:316-322.
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