both sectors. Furthermore, because the problems with patient records affect both public and private organizations, acceptance of a solution would be more likely if both sectors were involved in the decision making process.

The drawbacks of a public-private entity should not be underestimated, however. Managing the diverse interests that would be represented in such an organization presents a major challenge. Certain federal agencies already have charters that would overlap the charge to such an organization. In addition, a purely private sector organization might offer more entrepreneurial agility than a hybrid group. Perhaps the biggest drawback of a public-private organization is the inherent instability of such an approach. Lacking a federal mandate and given the less-than-immediate contribution to the profitability of private sector participants concerned with CPR development, a public-private organization may not command sufficient resources and attention to address effectively the barriers to CPRs and CPR systems.

Preferred Approach

The committee recognizes that the federal sector has considerable resources (including authority and knowledge) to influence CPR development. For example, HCFA can establish reimbursement mechanisms that reward providers who submit insurance claims generated by CPR systems. AHCPR is expressly mandated to improve patient data for research. The VA and DoD have gained considerable experience in CPR development and implementation. NLM has made significant contributions to the management of medical knowledge for practitioners.

Nevertheless, several factors militate against a purely federal approach. First, the resources, potential change agents, and stakeholders that must be coordinated or engaged in CPR development are present in both the public and private sectors. Thus, a structure is needed that can draw from both sectors. Second, the committee believes that routine use of the CPR can be achieved most efficiently through a collaborative process that develops consensus on key issues (e.g., data and security standards, the minimum content of CPR systems) yet allows flexibility at the local level to foster innovation in the development and use of CPRs.

Third, the committee believes that patient care should be the primary focus of CPR development and implementation. Practitioner use of CPR systems requires that the systems meet practitioner needs, and only if practitioners are willing to use CPR systems to capture data and to secure assistance in clinical decision making can the benefits of CPRs for moderating costs and conducting research be realized. It is essential that practitioners view the CPR as a valuable resource for improving patient care. Thus, CPR efforts must involve health care providers as well as federal agencies.

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