state-of-the-art components of CPR systems. Several systems developed in recent years have been designed and tailored to serve the special needs of nearly all members of the health care team in a variety of health care settings.

This section discusses a few key attributes of selected operational clinical systems that effectively utilize some portion of a computer-based patient record. There has been no attempt to provide an exhaustive presentation here of all the clinical systems developed to date. Rather, the discussion below focuses on systems that embody one or more special features crucial to the successful implementation of the complete CPR, especially within certain practice settings. These include (1) physician offices and group practice settings, (2) health maintenance organizations, (3) single hospitals or medical centers, and (4) large multihospital systems. By a large margin, the majority of patient care is provided in the office or group practice setting; as a result, systems that specifically address the needs of practitioners and patients in this environment will probably encounter the most substantial challenges and have the greatest impact. Therefore, although only two systems in this category are discussed below (many others have been developed or are currently under development), it should be understood that this category comprises perhaps the most important settings for CPR systems in terms of the potential for improved care. In addition to the discussion of clinical systems, the section also describes a few international developments of special interest and selected emerging developments.

Physician Offices and Group Practice Settings

The Medical Record

For more than 20 years, the Duke University Medical Center8 has been developing a comprehensive medical information system known as The Medical Record (TMR). The TMR system was first conceived as a tool for clinicians in outpatient settings; it was subsequently expanded to address the needs of clinicians in inpatient settings (Hammond and Stead, 1986). From the outset of the project, the CPR was considered the centerpiece of the TMR system (Stead and Hammond, 1988). The system can store and retrieve and data contained in a traditional paper record in an ambulatory or inpatient setting, with the exception of images such as X-rays. In an inpatient


William E. Hammond of Duke University Medical Center supplied the explanation and description of the TMR system. Where possible, the information was checked for consistency with published articles in peer-reviewed journals. The Medical Record and TMR are registered trademarks of Database, Inc.

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