The committee assigns high priority to these legal and regulatory issues because they pose major obstacles for steady progress toward the CPR and may take a long time to resolve. For this reason, the committee suggests that the CPRI convene a panel of experts to conduct such a review and prepare a report, including guidelines for state and congressional consideration. The committee also suggests that the CPRI disseminate the findings of the report through educational conferences and other means.

RECOMMENDATION 6. The costs of CPR systems should be shared by those who benefit from them. Specifically, the full costs of implementing and operating CPRs and CPR systems should be factored into reimbursement levels or payment schedules of both public and private sector third-party payers. In addition, users of secondary databases should support the costs of creating such databases.

The committee believes that capturing complete and accurate clinical data is an essential element of the patient care process; it sees the CPR as an essential tool for improving and evaluating the quality of patient care and for decreasing its costs. Short-run benefits of CPRs and CPR systems should include (1) improved patient care resulting from increased availability of patient data, medical knowledge, and clinical aids (e.g., decision support); (2) increased productivity of health care professionals from improved access to patient data and reduction of redundant data recording; and (3) reduction in administrative costs. Long-run benefits should include the ability to increase and improve medical knowledge through research using patient data derived CPR systems.

As discussed in Chapter 4, the current distribution of costs and benefits of CPR systems may not provide adequate investment incentives for health care provider institutions. To overcome this problem, the committee believes that a better understanding of the costs and benefits of CPR systems (as discussed earlier in this chapter) and some sharing of CPR costs will be needed. Cost sharing would encourage health providers to invest in CPR systems and thus move the nation toward an optimal level of CPR system use. Further, the existence of cost-sharing mechanisms would send a signal to CPR developers regarding the strength of the CPR market and should increase the willingness of developers to invest in additional R&D.

The costs associated with CPR systems go beyond one-time procurement expenses, entailing expenditures for installation, training, maintenance, and other activities that must be planned for and appropriately budgeted. The committee therefore suggests that reimbursement mechanisms address three kinds of CPR system costs for all health care providers: (1) costs associated with procurement or leasing, (2) costs associated with installation and implementation (including training), and (3) costs associated with operation and maintenance.

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