CPR design should not be driven solely by governmental objectives—for example, those embodied in the cost-containment and health outcomes research missions of HCFA and AHCPR, respectively. Although those agencies are likely to have significant interest in CPR development, their primary mission is not patient care.

The committee concluded that a public-private approach would be optimal in the long run and, as elaborated in Chapter 5, proposes the establishment of a Computer-based Patient Record Institute (CPRI). It was also of the view that the potential base of funding in the private sector is not sufficiently solid to provide adequate support for a new organization at this time. This judgment was founded on its review of the history of CPR development and on a poll of the participants at the workshop noted earlier. As a result, the committee also concluded that a federally initiated and funded approach would be most appropriate for necessary interim activities.

Immediate action is needed to advance CPR efforts and to lay the groundwork for an organization such as the CPRI that would ultimately coordinate the necessary infrastructure for a national CPR system. Many of the barriers to CPR implementation relate to lack of information; part of the interim effort thus should focus on education and evaluation. Standards development and representation of the interests of health care in the national high-speed computer network discussed earlier should also be given high-priority attention. The overall goal of such efforts would be, within five years, to turn over operational issues to a public-private organization that is supported mainly by its members.

The committee noted that if the private sector failed to support CPR efforts adequately, the federal government might still be sufficiently motivated to advance the CPR unilaterally. Long-term dominance by the federal government in this area could result in an approach that was more regulatory and bureaucratic than collaborative and innovative. To preclude such an eventuality, the committee placed special importance on joint public and private sector progress.

This approach is consistent with the recent General Accounting Office report on automated medical records (GAO, 1991), which made two recommendations to the secretary of Health and Human Services. First, as part of DHHS's mandate to conduct research on outcomes of health care services, the secretary should "direct the Public Health Service, through its Agency for Health Care Policy and Research, to support the exploration of ways in which automated medical records can be used to more effectively and efficiently provide data for outcomes research" (GAO, 1991:26). Second, as part of the effort to support outcomes research, the secretary should "develop a plan and budget for consideration by the Congress, to bring about the greater use of automated medical records" (GAO, 1991:26). Specific elements of such a plan could include "a national forum that

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