1. More powerful, affordable technologies to support computer-based patient records are now available.
  2. Increasingly, computers are being accepted as a tool for enhancing efficiency in virtually all facets of everyday life.
  3. Demographic factors such as an aging population (which results in a growth in chronic diseases) and the continued mobility of Americans create greater pressures for patient records that can manage large amounts of information and are easily transferable among health care providers.
  4. Pressures for reform in health care are growing, and automation of patient records is crucial to achievement of such reform.

The combination of these factors led the committee to conclude that computerization can help to improve patient records and that improved patient records and information management of health care data are essential elements of the infrastructure of the nation's health care system.

User Needs and System Requirements

The patient record of the future will have many more users and uses than it has at present. Direct providers of care (physicians, nurses, dentists, and other health care professionals) will remain the users of highest priority in design considerations. However, with the expanded functions projected for patient records (e.g., their use in supplying data for research or for insurance claims), the range of users considered in record system design will widen. The needs of all users will be met to an extent not possible in current record systems. Ultimately, of course, the most significant beneficiary of improved patient records should be the patient.

The committee identified five objectives for future patient record systems. First, future patient records should support patient care and improve its quality. Second, they should enhance the productivity of health care professionals and reduce the administrative costs associated with health care delivery and financing. Third, they should support clinical and health services research. Fourth, they should be able to accommodate future developments in health care technology, policy, management, and finance. Fifth, they must have mechanisms in place to ensure patient data confidentiality at all times.

To achieve these objectives, future patient records must be computer-based. However, merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs. The committee defined the computer-based patient record as an electronic patient record that resides in a system specifically designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support



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