The Computer-Based Patient Record An Essential Technology for Health Care, Revised Edition (1997) / Chapter Skim
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5 Improving Patient Records: Conclusions and Recommendations
5 Improving Patient Records: Conclusions and Recommendations
Pages 176-196
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From page 176... ...
CPRs can play an important role in improving the quality of patient care and strengthening the scientific basis of clinical practice; they can also contribute to the management and moderation of health care costs. The Institute of Medicine (IOM)
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. ~ This chapter summarizes the committee's principal conclusions and presents recommendations for improving patient records (see Box 5-1~.
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From page 178... ...
THE COMPUTER-BASED PATIENT RECORD CONCLUSIONS Patient records are the primary repository of data in the informationintensive health care industry. Although clinical information is increasingly likely to be computerized, the current, predominant mode for recording patient care data remains the paper record.
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From page 179... ...
Barriers to CPR development include development costs and lack of consensus on CPR content. CPR diffusion is adversely affected by the disaggregated health care environment, the complex characteristics of CPR technology, unpredictable user behavior, the high costs of acquiring CPR systems, a lack of adequate networks for transmitting data, a lack of leadership for resolving CPR issues, a lack of training for CPR developers and users, and a variety of legal and social issues.
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From page 180... ...
as the standard for medical and all other records related to patient care. The committee believes that future patient records must be more than a way to store patient data they must also support the clinical decision process and help improve the quality of patient care.
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6. The CPRis accessible for use in a timely way at any and all times by authorized individuals involved in direct patient care.
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to promote and facilitate development, implementation, and dissemination of the CPR. The committee identified a series of activities to facilitate CPR development and implementation: (1)
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· Educate change agents and stakeholders (including the general public and health care professionals) about the value of computer-based patient records in improving patient care.
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From page 184... ...
A purely private sector effort also has little likelihood of success: past history shows that private sector CPR development has been fragmented, unique to particular institutions, and generally underfunded. Indeed, the base of funding in the private sector is not sufficiently solid to support a new organization at this time.
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From page 185... ...
An advisory board with representation from both the private and public sectors should also be established. Program staff would support standards activities, conduct educational programs, serve as liaisons to professional organizations and commissions, represent the health care community in National Science Foundation network discussions, advise AHCPR and other extramural funders of research and demonstration projects, and plan for the second phase of CPR development and implementation.
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From page 186... ...
Data Acquisition The single greatest challenge in implementing the CPRis to develop a technology that is sufficiently powerful and appropriate to the needs and preferences of health care professionals so that they can and will enter medical and other health care data directly into the computer. Significant new technologies (e.g., graphical user interface, voice-recognition technology, high-resolution computer displays, high-speed communication networks, and hand-held data-entry devices)
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From page 187... ...
and health data standards groups to develop clinical data dictionaries should be coordinated to ensure a reasonable level of consistency and compatibility. The committee suggests that the CPRI foster efforts to establish a composite clinical data dictionary that would enable users to translate data from different systems to equivalent meanings.
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From page 188... ...
The committee urges that the NLM be granted increased funding over the same period to refine the UMLS further, particularly the vocabulary involved in patient care and access to clinical knowledge bases. The NLM is the appropriate organization to educate the health care community concerning UMLS and other clinical vocabulary activities, and it is well positioned to do so effectively.
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From page 189... ...
To remedy this inadequacy, the CPRI should become an active participant in discussions by the Federal Networking Council regarding the National Research and Education Network. Cost-Benefit Analysis In view of the substantial direct costs of CPR development and implementation, issues of cost-effectiveness are important from both institutional and societal perspectives.
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From page 190... ...
To obtain a more accurate picture of costs and benefits will require major R&D efforts for instance, extensive modeling and simulation projects or community-based demonstrations that could later be generalized beyond the community sites. An especially important step will be for investigators to develop sound models of total costs and benefits because it is likely that the CPR will range into areas of function and value far beyond those of current patient records.
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From page 191... ...
To use these capabilities most effectively, the committee believes the relationship between the structure of patient records and the quality of patient care should be explored further. For example, specific elements of patient records that contribute to patient care outcomes need to be identified for incorporation into CPR systems.
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From page 192... ...
Fourth, laws protecting confidentiality of computer-based patient data need to be strengthened to address concerns about patient privacy. The committee concluded that a comprehensive review of pertinent laws and regulations, especially state laws and regulations, is needed to remove potential legal barriers and to ensure adequate protection of patient privacy.
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From page 193... ...
improved patient care resulting from increased availability of patient data, medical knowledge, and clinical aids (e.g., decision support)
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From page 194... ...
An essential requirement for optimal functioning of CPR systems is efficient user operation of computers, CPRs, and CPR systems, including associated decision support, bibliographic retrieval, and other clinical aids. Because students and practitioners alike have educational needs in these areas, health care professional schools, programs, societies, and organizations all have a role to play in CPR education.
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From page 195... ...
Future RRA roles may also emphasize maintaining the quality and consistency of CPRs to support patient care and facilitate research using patient data. SUMMARY The Institute of Medicine study committee set out to develop a plan for improving computer-based patient records and the systems in which they reside.
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From page 196... ...
Further, achieving maximum benefit from CPR systems will require that they be linked to an information infrastructure (i.e., network) that allows patient data, medical knowledge, and other information to be transmitted and accessed when and where needed, subject to appropriate security and confidentiality measures.
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