of education programs by serving as a resource for curriculum and continuing education development.

The number of health care professionals who can design, develop, support, and train others in the use of state-of-the-art CPR systems is far fewer than the number needed. Therefore, the committee suggests that the CPRI support training programs in health care to address these personnel shortages.

The committee notes the special training needs of registered record administrators (RRAs) with respect to CPRs. As the CPR becomes more commonplace, the role of RRAs should evolve to keep pace with the changes in patient records. The RRA of the future is likely to require greater knowledge of computing technologies (including database systems and software), quality control procedures, and the needs of all patient record users. Future RRA roles may also emphasize maintaining the quality and consistency of CPRs to support patient care and facilitate research using patient data.


The Institute of Medicine study committee set out to develop a plan for improving computer-based patient records and the systems in which they reside. As its first step, the committee examined why previous attempts had not resulted in wide acceptance of CPRs and asked if and how another effort might be successful. It identified five conditions in the current health care environment that it believes increase the likelihood of success: (1) ever-increasing uses of and legitimate demands for patient data, (2) availability of more powerful and more affordable technologies to support CPRs and CPR systems, (3) widespread acceptance of computers as a tool to increase efficiency in virtually all facets of everyday life, (4) an aging, mobile population, and (5) a widely held belief that needed reform in health care will not be easily achieved without routine use of CPRs.

To accomplish its task, the committee identified both the strengths and weaknesses of current patient record systems, detailed the users and uses of patient records, and defined user requirements for patient records and patient record systems. It reviewed available and emerging technologies and highlighted crucial emerging technologies whose development should be encouraged. Further, it identified nontechnological barriers to the development and diffusion of CPRs.

The committee believes its recommendations effectively address these potential barriers to routine CPR use. The first recommendation defines the CPR as the standard for future patient records. The second proposes an organizational framework within which CPR barriers can be systematically addressed and overcome. The committee's remaining recommendations then focus on specific barriers: needed research and development, promulgation

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