This experiment is driven by the belief that information management in health care is a primary key to cost containment. Approximately 9,000 patient Care Cards (which includes cards for all diabetics in the area) are in routine use. Preliminary results of the test released in late 1990 reveal significant reductions in staff time devoted to clerical functions, a significant increase in patient-centered activities by clinicians, and significant reductions in orders for laboratory tests (presumably because recent test results were available from the Care Card). Patients themselves indicated significantly greater satisfaction with the care they have received since introduction of the cards in 1989 (only 2 percent expressed dissatisfaction; Hopkins, 1990).

England has also embarked on a large experiment in which more than 16,000 general practitioners have installed personal computers in their offices to support clinical practice. This figure represents approximately half of all general practitioners in the country and is perhaps the most substantial (in terms of numbers of practitioners) clinical computing experiment undertaken to date. These and other experiments in Europe imply that Europeans have significant experience in developing clinical data standards, perhaps more than most other regions of the world. Further, they indicate the very real need for greater international cooperation in formulating future health care data standards.

Selected Emerging Developments

Once a patient's clinical data are in machine-readable form, many decision making aids will be available to health care professionals to permit them to take advantage of the latest information on problems specific to the patient. In addition, clinical data in the CPR may support other capabilities that can help ensure higher quality care, one beneficial consequence of which may be a reduction in the rate of malpractice suits. Several of these recently developed decision making aids are described below.

Chart Checker

Kaufman and Holbrook (1990) describe Chart Checker, a software package that operates in conjunction with the machine-readable emergency room record. Chart Checker analyzes the emergency room record narrative to alert the emergency room physician to potentially serious diagnoses that he or she may have overlooked or dismissed too quickly. This capability is particularly important for preventing malpractice suits. For example, Kaufman and Holbrook (1990) noted that more than 30 percent of liability cases won against emergency room physicians resulted from missing a myocardial infarction. Chart Checker has been tested using emergency room narratives

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