current patient records will perpetuate their deficiencies and will not be sufficient to satisfy emerging user demands. If future patient records are to be an asset in patient care, they must offer broader functions than those provided by the record systems of today.

The future patient record will be a computer-based, multimedia record capable of including free text, high-resolution images, sound (e.g., auscultations), full-motion video, and elaborate coding schemes. CPR systems will offer access (availability, convenience, speed, reliability, and ease of use), quality, security, flexibility, connectivity, and efficiency. In addition, future patient records will provide new functions through links to other databases and decision support tools.

No contemporary clinical information systems are sufficiently comprehensive to be considered full CPR systems. Several existing systems, however, offer prototypes of components of CPR systems.

The committee considers nine technological capabilities to be essential to CPR systems: (1) databases and database management systems, (2) work-stations, (3) data acquisition and retrieval, (4) text processing, (5) image processing and storage, (6) data-exchange and vocabulary standards, (7) system communications and network infrastructure, (8) system reliability and security, and (9) linkages to secondary databases.

No new technological breakthroughs are needed to develop robust CPR systems, but some emerging technologies are crucial. Low-cost yet powerful clinical workstations and improved human interface technologies are needed. Voice-recognition systems, high-capacity networks (e.g., fiberoptic), and open-architecture systems will be required to achieve broad adoption of CPR systems. Emerging clipboard-sized computers that accept input through a hand-held stylus may also prove to be a critical development. In addition, CPR diffusion requires development of standards for health care data and greater emphasis on protecting the integrity and confidentiality of CPR data.

Technology is not the only potentially limiting factor in advancing CPR systems; informational, organizational, and behavioral barriers must also be addressed. Barriers to CPR development include development costs and lack of consensus on CPR content. CPR diffusion is adversely affected by the disaggregated health care environment, the complex characteristics of CPR technology, unpredictable user behavior, the high costs of acquiring CPR systems, a lack of adequate networks for transmitting data, a lack of leadership for resolving CPR issues, a lack of training for CPR developers and users, and a variety of legal and social issues.

The committee developed a plan for advancing the development and implementation of CPRs and CPR systems that identifies a broad group of stakeholders who would be affected (both positively and negatively) by CPR system implementation. It also identifies a group of organizations



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