THE COMPUTER-BASED PATIENT RECORD -- Copyright -- Preface-Revised Edition -- Preface-Original Edition -- Acknowledgments-Revised Edition -- Acknowledgements-Original Edition -- Contents -- Commentary -- A Progress Report on Computer-Based Patient Records in the United States -- THE CHANGING HEALTH CARE LANDSCAPE: REINFORCING THE NEED FOR CPRS -- The Evolving Role of Primary Care -- The Integrated Delivery System -- Technological Advances -- The Internet and the World Wide Web: Widespread Connectivity -- World Wide Web Browsers: A Universal View on the Internet -- The Intranet -- Network-Centric Computing -- THE CURRENT STATE OF CPRS -- The CPR Market -- Integrated View of Patient Data -- Access to Knowledge Resources -- Physician Order Entry and Clinician Data Entry -- Integrated Communications Support -- Clinical Decision Support -- At the Fork -- Recent Activity to Advance CPRs in the United States -- Remaining Barriers or Challenges -- Definition of the CPR -- Meeting User Needs -- Standards -- Legal and Social Issues -- Costs and Benefits -- Leadership -- CONCLUSION -- ACKNOWLEDGMENTS -- REFERENCES -- Commentary -- A Progress Report on Computer-Based Patient Records in Europe -- THE CURRENT STATE OF CPRS IN EUROPE -- CPR SYSTEMS IN PRIMARY CARE -- Role of GPs -- Training -- Structure of Health Care -- Population-Based Care -- CPR SYSTEMS IN HOSPITALS -- Platforms for CPRs -- Integrated CPRs -- CPR Data Entry -- Natural Language Processing -- Structured Data Entry -- CPR SYSTEMS FOR SHARED CARE -- CoCo -- Diabcard -- USE OF CPR DATA -- Critiquing a Physician's Care -- INTEGRATION OF PROTOCOLS WITH CPR SYSTEMS -- Review of CPR Databases -- ADDRESSING BARRIERS -- Privacy and Confidentiality -- Standardization -- Electronic Health Care Record Architecture -- Coding Systems for Drugs -- Syntax for Health Care Data Interchange.

Exchange of Medical Images and Related Data -- User Identification -- CONCLUSION -- REFERENCES -- Summary -- USER NEEDS AND SYSTEM REQUIREMENTS -- COMPUTER-BASED PATIENT RECORD TECHNOLOGIES -- NONTECHNOLOGICAL BARRIERS -- RECOMMENDATIONS -- 1 Introduction -- THE STUDY -- The Committee's Charge -- Committee Activities -- Definitions -- REPORT ORGANIZATION -- THE PATIENT RECORD -- Strengths and Weaknesses of Paper Patient Records -- Problems with Patient Record Content -- Problems with Format -- Problems with Access, Availability, and Retrieval -- Problems with Linkages and Integration -- Outpatient Records -- INFORMATION MANAGEMENT CHALLENGES -- An Information-Intensive Industry -- An Information Explosion -- Increasing Demand for Data -- Maintaining Confidentiality -- INFORMATION MANAGEMENT OPPORTUNITIES -- BEYOND TECHNOLOGY -- WHY NOW? -- REFERENCES -- 2 The Computer-Based Patient Record: Meeting Health Care Needs -- DEFINING HEALTH CARE NEEDS -- Patient Record Users -- Patient Record Uses -- TRANSLATING CUSTOMER NEEDS INTO SYSTEM REQUIREMENTS -- Patient Record Functions -- Storage -- Guidance of Clinical Problem Solving -- Practitioner Support -- Implementation and Operation Issues -- THE FUTURE PATIENT RECORD -- REFERENCES -- 3 Computer-Based Patient Record Technologies -- TECHNOLOGICAL BUILDING BLOCKS FOR CPR SYSTEMS -- Databases and Database Management Systems -- Databases -- Database Management Systems -- Workstations -- Data Acquisition and Data Retrieval -- Data Acquisition -- Data Retrieval -- Text Processing -- Image Processing and Storage -- Data-Exchange and Vocabulary Standards -- System Communications and Network Infrastructure -- System Reliability and Security -- Linkages to Secondary Databases -- EXPERIENCE WITH CPR SYSTEMS -- AN OVERVIEW OF CPR SYSTEMS -- Physician Offices and Group Practice Settings -- The Medical Record.

Health Maintenance Organizations -- Computer-Stored Ambulatory Record Systems -- Single Hospitals or Medical Centers -- Theresa System -- Health Evaluation Through Logical Processing -- Beth Israel and Brigham and Women's Hospital System -- Lockheed's Early Clinical Information System -- Large Multihospital Systems -- Department of Veterans Affairs -- Department of Defense -- International Developments -- The Exmouth Project -- Selected Emerging Developments -- Chart Checker -- Problem-Knowledge Coupler -- Medical Logic Modules -- CLINICIAN INTERACTION AND RESISTANCE -- TECHNOLOGICAL BARRIERS -- The Human Interface and System Performance -- Text Processing -- Confidentiality and Security -- Health Data-Exchange Standards -- SUMMARY -- REFERENCES -- Appendix: the Computer-based Patient Record System Vendor Survey -- GENERAL OBSERVATIONS -- SURVEY FINDINGS -- 4 The Road to CPR Implementation -- DEVELOPMENT AND DIFFUSION FACTORS -- Barriers to Development -- Patient Record Definition -- Content and Format Standards -- Costs and Risks -- Barriers to Diffusion -- Environment of the Health Care System -- Leadership -- User Behavior, Education, and Training -- Costs -- Legal and Social Issues -- Network Needs -- ELEMENTS OF AN IMPLEMENTATION STRATEGY -- Change Agents and Stakeholders -- Health Care Professionals and Professional Associations -- Patients and Representatives of Patients -- Provider Institutions -- Third-party Payers -- Federal Government -- States -- Universities and Professional Schools -- Standard-setting Organizations -- Vendors -- Activities and Resources Critical to CPR Development -- Organizational Structure -- Federal Agency -- Private Sector Sponsorship -- Public-Private Commission or Consortium -- Preferred Approach -- Specific Steps for Change Agents -- SUMMARY -- REFERENCES.

Appendix: Maternal and Child Health Care and Computer-Based Patient Records -- 5 Improving Patient Records: Conclusions and Recommendations -- CONCLUSIONS -- RECOMMENDATIONS -- Data Acquisition -- Data and Security Standards -- Data Standards -- Security Standards -- Networking Support -- Cost-Benefit Analysis -- Quality Assurance -- Structure and Format of the Patient Record -- SUMMARY -- Appendix A Subcommittees -- USERS AND USES SUBCOMMITTEE MEMBERS -- TECHNOLOGY SUBCOMMITTEE MEMBERS -- STRATEGY AND IMPLEMENTATION SUBCOMMITTEE -- Appendix B Legal Aspects of Computer-based Patient Records and Record Systems -- STATE LICENSURE LAWS -- Hospital Licensure Laws as Barriers to Full Automation -- Other State Licensure Laws -- Medicare Regulations -- Hospital Accreditation Requirements -- PATIENT RIGHTS ISSUES -- Right of Privacy -- Right of Access to Health Records -- Ownership of Patient Data and of the Patient Record -- Ownership of the Patient Record -- Rights in Information Contained in the Record -- EVIDENTIARY ISSUES -- Importance of Admissibility of Patient Records as Evidence -- Rule Against Hearsay -- Definition of Hearsay -- Business Records Exception -- Best Evidence Rule -- RISKS ARISING FROM COMPUTER-BASED PATIENT RECORD SYSTEMS -- Breaches of Confidentiality and Unauthorized Access -- Computer Viruses and Other Computer Sabotage -- Potential for Inaccessibility -- Questions of Durability -- Accuracy Issues -- Selected Legal Issues in Computer Contracting -- OVERCOMING LEGAL BARRIERS TO COMPUTER-BASED PATIENT RECORDS AND RECORD SYSTEMS -- Adoption of Uniform National Licensure Standards and Health Information Laws -- Overcoming Special Legal Risks Related to Computer-based Patient Records -- CONCLUSION -- Index.