The concept of a computer-based patient record (CPR) system was born in the early days of computing, and much effort went into automating portions of the medical record for all patients and all of the medical record for selected categories of patient. The difficulty has always been that no consensus exists regarding exactly how the medical record should be structured (even when it is in the form of a paper record) or how it should be used in the delivery of health care--a situation that is not very different from the role of CASE in software engineering. The Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine prepared this report on the CPR. Not surprisingly, the committee “believes that CPRs and CPR systems have a unique potential to improve the care of both individual patients and populations and, concurrently, to reduce waste through continuous quality improvement.”
What is important about this book is not just the above conclusion, which has appeared in the medical informatics literature for more than a decade. Its contribution is a clear and timely review of the state of the art and the state of the practice in CPR systems. The book contains an introduction that reviews several decades of study of paper medical records and summarizes their strengths and weaknesses in health care. (The committee found no documented strengths.) The introduction also identifies some of the information management challenges that now confront a modern health care facility, and it concludes that the technology is available to support a more widespread acceptance of the CPR.
Chapter 2 discusses the CPR in the context of meeting health care needs. The first section defines the needs and converts those needs into system requirements. The functions are identified, and the implementation and operational issues are addressed. Chapter 3 contains a survey of the technologies used for CPR systems. One section addresses computer technology issues (such as databases, workstations, and communications), and a second section surveys experiences with CPR systems. Most of the well-known systems are identified and discussed briefly. The authors point out that many of these systems originated in an academic setting and are neither of commercial quality nor transportable. A final section in this chapter reviews the technological and human barriers to the adoption of CPR systems. Chapter 4 considers the road to CPR implementation. It covers the development and diffusion factors and introduces a development strategy. Each chapter contains a useful set of references.
The final chapter provides the committee’s conclusions and recommendations. An appendix discusses the legal aspects of CPRs and CPR systems. The book was intended for a broad health care audience, and those working with computer technology in this area will find the book valuable. It will also make interesting reading for those involved with technology transfer. Its primary focus, however, is on computer-based patient records and not on the technology used to support them.