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diffusion sometimes parallels the development of a new technology (NAS, 1979). Moreover, as discussed below, the factors affecting development and diffusion are interrelated: development is unlikely to occur if the conditions for diffusion are unfavorable.
Barriers to Development
Patient Record Definition
A basic impediment to the development of CPRs and CPR systems has been the lack of a clear definition of what a CPR could and should be. An intellectual understanding of what a CPR needs to do, the range of individuals for whom it needs to function, and the expectations and performance demands of its users is an essential prerequisite to successful design of a CPR system (Teach and Shortliffe, 1981). Many computer-based information management systems are currently in place and generate and use patient data for various purposes (e.g., billing, laboratory, radiology); what is lacking is a unified concept of what constitutes a computer-based patient record system.
A fully articulated definition of a CPR and CPR system should describe attributes of the record and system (i.e., content, format, and function) as a guide for system developers and users.1 It should not, however, prescribe how those attributes are to be achieved. Resolution of that question is best left to CPR system developers and vendors.
Chapter 2 identifies basic CPR system requirements, but system designers require more detailed specification in certain areas. Among these are the level of performance (e.g., speed and convenience) the system must provide to achieve health care provider acceptance; the kinds of new system functions needed to justify a change in current routines of record use and the costs of implementation; the frequency with which multiple users would view the record simultaneously; the level of system security, confidentiality, and reliability required; and the level of institutional, regional, national, or international interconnectivity demanded of the system.
In particular, patient record system developers require specific information about system functionality and performance to design systems that meet user needs. Understanding the diverse set of CPR user needs requires that representatives of all users be involved in a process of setting priorities for system functionality and performance.
As discussed in Chapter 1, the committee's definition of a CPR is an electronic patient record that resides in a system specifically designed to support users through the availability of complete, accurate patient data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.