a plan would establish priorities for CPR development within and among activities (e.g., define where data standards are most needed or where they could be applied most quickly). By defining and coordinating the roles of key change agents, the CPR can help focus attention on the most important tasks and avoid redundancy of effort. Moreover, by tracking and reporting concrete progress toward CPR development, the CPRI can help maintain and perhaps continue to increase interest in and resources for CPR development. It is essential that the CPRI and all organizations and individuals associated with CPR development build on existing efforts. For example, CPRI can work with the Agency for Health Care Policy and Research (AHCPR) to identify needed progress for existing databases so that secondary user needs can be better met during the transition to CPRs.

The committee, for several reasons, concluded that in the long run an independent public-private organization would be the optimal structure for the CPRI. No one federal agency would have the prestige, funding, or personnel to pursue a complete CPR agenda successfully; in addition, suspicion or skepticism on the part of the private sector (both the business and the health care communities) regarding a purely governmental effort would be difficult to overcome. The committee emphasizes that if the CPRI is to be successful, it must represent all patient record users, particularly practitioners.

A purely private sector effort also has little likelihood of success: past history shows that private sector CPR development has been fragmented, unique to particular institutions, and generally underfunded. Indeed, the base of funding in the private sector is not sufficiently solid to support a new organization at this time. In addition, it is unlikely that private sector activities can overcome intentional and unintentional governmental barriers, such as the myriad state laws and regulations that hamper progress in this area. Furthermore, certain government agencies (notably the Departments of Defense and Veterans Affairs) have made more progress in this area than the private sector, and that work should be incorporated into any national effort.

Ultimately, the committee concluded that a federally initiated and funded approach would be most appropriate for inaugurating the necessary activities. The goal of such an interim effort would be to turn over, within five years, CPR coordination efforts to a public-private organization supported by its members. The committee thus recommends a two-phase strategy for the establishment of the CPRI. In the first phase, the secretary of the Department of Health and Human Services should establish an office or program to organize specific activities aimed at reducing the barriers to computer-based patient record development. In the second phase, the CPRI should be established as a public-private organization dedicated to coordinating the many activities needed to facilitate widespread use of the CPR.

The main goals of the initial federal program should be to respond to immediate needs to advance CPR efforts and to lay the groundwork for the



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