computer-based patient record and the data that should be captured in it. Vendor responses suggested that the industry viewed direct data entry as desirable, but they also reflected industry pessimism about whether physicians and nurses could be convinced to actually enter data (although three vendors stated that they had implemented systems in which direct data entry by practitioners was occurring). Other impediments to the immediate implementation of CPRs today, as opposed to in the future, included the cost of the system, general resistance to change within the health care industry, the need for data sharing among many different kinds of systems (including departmental systems), and the lack of a good decision support system.

Vendors showed more agreement in their view of the forces that could propel the medical record environment into the computer age. Most cited the increasingly broad range of medical record users, which mandates a patient record with expanded access. Strong consensus emerged regarding the CPR as a tool with the potential to benefit every aspect of the health care environment. Vendors also voiced some skepticism, however, that the CPR could receive the broad-based, organization-wide support required for its implementation and use in a hospital.

According to the vendor responses, technologies commonly believed to be 5 to 10 years distant are, in fact, already being employed in workable CPR systems. Three vendors claimed that they had implemented a full-scale electronic medical record in a hospital environment: one in a facility of unspecified size, the second in a hospital of 176 beds, and the third in a large, urban teaching hospital of more than 900 beds. Two of these vendors offered decision support systems, one of which was described as a powerful report-writing system and the other as an actual interactive decision support system. The survey responses also indicated that direct data entry by patient care practitioners was feasible, resistance to change notwithstanding, provided the CPR system was user-friendly and was perceived as improving quality and reducing costs for the hospital, clinic, or practice. Taken together, the survey responses appeared to suggest that the environment is right for the implementation of CPRs in hospitals—that is, if enough of the system's beneficiaries can be convinced that such a comprehensive system justifies the difficulties of implementation.

Survey Findings

FINDING 1. Close reading of the responses generates some skepticism about whether all of the named products meet the requirements of a comprehensive CPR system. This may be the case in part because too few of the necessary patient record components have been automated.

FINDING 2. The majority of the systems noted in the survey operate in

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