with insurers and health care provider institutions that use or support CPR systems.
EXECUTIVE AGENCIES Federal agencies have varying degrees of interest in and authority to influence CPR development and implementation. Certain agencies can provide substantial funding for research and development; others may be able to finance the acquisition of CPR technology. Federal agencies can support standards development through funding or regulatory mandate. For instance, they can direct major federal providers of health care to use CPR equipment that meets certain standards, or they can require the use of CPR technology for hospital accreditation or Medicare participation. The remainder of this section outlines the change agent and stakeholder roles of selected federal departments and agencies.
Within the Department of Health and Human Services (DHHS), the Public Health Service agencies10 would benefit greatly from efficient access to complete, accurate patient care data; therefore, their interest in CPRs is likely to be high. For example, the Agency for Health Care Policy and Research (AHCPR) is charged to develop uniform definitions of data to be collected and used in describing a patient's clinical and functional status; it also supports the development of common reporting formats and linkages for such data and of standards to ensure data security, confidentiality, accuracy, and maintenance (U.S. Congress, 1989). These activities support or would be supported by CPR implementation.
The research institutes of the National Institutes of Health (NIH) are viewed as stakeholders who would benefit from improved patient data. Within NIH, the National Library of Medicine (NLM) is in a strong position to support CPR development directly through its medical informatics program and its work on the Uniform Medical Language System (UMLS). Further, MEDLINE, HEALTH, and other on-line databases of the NLM's MEDLARS (Medical Literature and Retrieval Systems) are valuable resources for health care professionals that could be made available through CPR workstations.
The Centers for Disease Control (CDC) and the FDA could each benefit from the implementation of CPR systems in two ways. First, CPR implementation would likely improve patient data for epidemiological research.
These agencies include the Agency for Health Care Policy and Research, the Centers for Disease Control (including the National Center for Health Statistics), the Food and Drug Administration, the Health Resources and Services Administration, the Indian Health Service, and the National Institutes of Health (including the National Library of Medicine).