Landmark study update sees slow progress in CPR
Payment technology needed now more than ever
Despite more than 30 years and millions of dollars of research, the universal computer-based patient record (CPR) remains as elusive as ever in American health care.That’s the conclusion reached by the authors of an update of the landmark 1991 patient record study, The Computer-Based Patient Record: An Essential Technology of Health Care sponsored by the Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine in Washington, DC.
Paper still dominates
"Patient records today are still predominately paper records. This evident lack of diffusion of information management technologies in the health care sector has limited the tools available for effective decision making from the bedside all the way to the formulation of national health care policy," write Paul C. Tang, MD and W. Ed Hammond, PhD, both past chairs of the Computer-based Patient Record Institute, and authors of the American portion of the study.Progress in moving toward the CPR is such an important topic in light of recent changes in health care that the Institute of Medicine took the unusual step of commissioning a revised edition of the study.
Despite the less than glowing report on the state of the CPR, the authors are optimistic that a universal CPR will succeed because:
• The uses of and demands for patient data are growing.
• More powerful, affordable technologies to support the CPR are now available.
• Computers increasingly are being accepted as a tool for enhancing efficiency in virtually all facets of everyday life.
• Demographic factors such as an aging population — with accompanying chronic diseases — and Americans’ mobility increase the need for patient records that can manage large amounts of information and are easily transferable among health care providers.
• Pressures for health care reform are growing and automation of patient records is crucial to achievement of such reform.
But the definition of a CPR must be broadened, the authors say. (See definition, below.) "In the past, a patient record has served the basic function of storing patient data for retrieval by users involved with providing patient care. Different health care professionals will require different modes of record information retrieval and display.
Today, both paper and computer records are often cumbersome tools for these tasks. The record of the future must be far more flexible, allowing its users to design and utilize reporting formats tailored to their own special needs and to organize and display data in various ways."
The patient record system of the future must be broadened to include other capabilities as well, including:
• links to administrative, bibliographic, clinical knowledge, and research databases;
• links to decision support systems;
• support of video or picture graphics;
• electronic mail within and between providers;
• the ability to transmit detailed records reliably across substantial distances.
In addition, physician offices must be able to communicate with local hospitals and national libraries. In hospitals, all of the many departmental computer systems must be able to communicate with the patient record system. And in the health care system at large, computer-based information management systems must be able to communicate with providers, third-party payers, and other health care entities while maintaining patient privacy.
Although no current CPR fulfills all those criteria, the authors write, the most successful ones share these common traits:
• They maintain a large data dictionary to define the contents of their internal CPRs.
• All patient data recorded in the CPR are tagged with the time and date of the transaction, making the CPR a continuous chronological history of the patient’s medical care.
• The systems retrieve and report data in the CPR in a flexible manner.
• The systems offer a research tool for using the CPR data.
[The revised edition of The Computer-based Patient Record: An Essential Technology for Health Care can be obtained by calling the National Academy Press (800) 624-6242. The book can also be ordered through the National Academy Press Web site at http://www.nap.edu/bookstore. The price is $34.95 if ordered by phone; $27.96 if oredered via the Internet.]
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