programs tailored to different types of health care professionals must be developed. The committee considered the educational barrier to CPR development sufficiently important to formulate a specific recommendation to address it, as discussed in Chapter 5.

In addition to education, practitioners need incentives to use CPRs to enter data and maintain patient records. Perhaps the greatest motivation for practitioners to use CPRs would be to produce evidence that CPRs can help to improve the quality of patient care and reduce the administrative burdens they currently face. As discussed in Chapter 3, at least one institution has experimented with a fee-for-data arrangement for physicians who input their own discharge summaries into an automated system. Other arrangements to encourage the use of CPRs are also feasible. For example, third-party payers could provide incentives for health care providers (including physicians) to submit claims electronically or in a computer-compatible format (e.g., diskette). Alternatively, third-party payers may reject reimbursement claims that do not contain standard data. A regulatory approach is another possibility for use in place of or in addition to an incentive structure. However, the potential side effects and costs of both incentives and constrictive regulations must be understood and carefully weighed.

Costs

A major factor influencing a firm's adoption of a technology is the size of the investment required relative to the size of the firm. Acquisition costs for CPR systems are likely to be substantial but are difficult to estimate.4 This difficulty arises because the purchase or lease price of a system does not reflect the total implementation cost; it excludes the cost of training and potential losses of productivity during transition to the system. Studies that have attempted to estimate total costs have tended to focus on MISs rather than CPR systems. Further, purchase or lease prices for CPR systems vary significantly, depending on the scope of functions a system offers, the size of an institution, and an institution's previous level of automation.

One cost analysis of the implementation and operation of an automated ambulatory care medical record system found that the cost per patient encounter of a computer-based system was 26 percent greater than the direct costs associated with operation of a manual system. However, the manual system failed to access 18 percent of the records requested within the demand

4  

A confidential survey of CPR vendors conducted by the Technology Subcommittee of this IOM study committee revealed that purchase or lease costs for a CPR system range from $2 million to $6 million for a medium-sized hospital (see the appendix to Chapter 3).



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