systems, links to bodies of medical knowledge, and other aids. This definition encompasses a broader view of the patient record than is current today, moving from the notion of a location or device for keeping track of patient care events to a resource with much enhanced utility in patient care (including the ability to provide an accurate longitudinal account of care), in management of the health care system, and in extension of knowledge.

In the past, a patient record has served the basic function of storing patient data for retrieval by users involved with providing patient care. Even this classic function must be broader in the future, however, especially with respect to the key feature of flexibility. Different health care professionals will require different modes of record information retrieval and display. Today, both paper and computer records are often cumbersome tools for these tasks. The record of the future must be far more flexible, allowing its users to design and utilize reporting formats tailored to their own special needs and to organize and display data in various ways.

The patient record system of the future must provide other capabilities as well, including links to administrative, bibliographic, clinical knowledge, and research databases. To meet the needs of clinicians, CPR systems must be linked to decision support systems; they must also support video or picture graphics and must provide electronic mail capability within and between provider settings.

Future CPR systems must offer enhanced communications capabilities to meet emerging user needs. The systems must be able to transmit detailed records reliably across substantial distances. Physician offices must be able to communicate with local hospitals and national bibliographic resources. In hospitals, all of the various departmental systems (e.g., finance, laboratory, nursing, radiology) must be able to communicate with the patient record system. In the larger health care environment, computer-based information management systems must be able to communicate with providers, third-party payers, and other health care entities, while at all times maintaining confidentiality of the information.

If users are to derive maximum benefits from future patient record systems, they must fulfill four conditions. First, users must have confidence in the data—which implies that the individual who collects data must be able to enter them directly into the system and that the system must be able to reliably integrate data from all sources and accurately retrieve them whenever necessary. Second, they must use the record actively in the clinical process. Third, they must understand that the record is a resource for use beyond direct patient care—for example, to study the effectiveness and efficiency of clinical processes, procedures, and technologies. Fourth, they must be proficient in the use of future computer-based record systems (i.e., the systems described in this report) and the tools that such systems provide (e.g., links to bibliographic databases or clinical decision support systems).