also performed the fiscal computing, accounts receivable dropped by 40 days.) The experience of Beth Israel and Brigham and Women's hospitals shows that clinical computer systems can drive nearly all patient billing functions and that they can do so more efficiently than separate machines dedicated only to patient billing. Slack (1989:140) notes that "more than 90% of each patient's charges are now collected as a byproduct of the clinical computing system." This important feature substantiates the dual notions that the CPR is or should be the central feature of all clinical systems and that it is capable of supporting nearly every functional component of the system, including billing.
One of the earliest demonstrations of a clinical information system came through the development of a system by the Lockheed Corporation between the mid-1960s and 1970s. Technicon, an early clinical system vendor, acquired the system from Lockheed; today, it is owned and marketed by a company called TDS. This system displays two distinct, powerful features crucial to the design of future CPR systems. First, it offers very fast response times (usually less than one second) for nearly all user input; second, it is extremely flexible. For example, it can support the diverse needs of many users at a single site because the system has been tailored to meet the expectations of several simultaneous users.
A pioneer and leader in this field, the Department of Veterans Affairs (VA) has been developing its clinical computing system, known as the Decentralized Hospital Computer Program (DHCP), for nearly a decade (Andrews and Beauchamp, 1989). By the late 1980s, the VA had installed DHCP in most of its more than 170 medical centers.15 Outpatient clinics and other care facilities, including nursing homes, operated by the VA gain access to systems through the VA's national network.
The VA's DHCP consists of software grouped into three categories: (1)
At the direction of Congress the VA has installed commercially developed clinical information systems in a few selected VA medical centers to test the VA's DHCP against systems from the private sector. All other VA medical centers have installed and are using the DHCP. All of the VA's medical centers thus use automated clinical systems—that is, one or the other of these two approaches.