desirable to examine two questions. First, to what extent have CPRs, as defined by the study committee, been developed? Second, to what extent have the available CPRs been adopted? Unfortunately, a comprehensive review of the industry does not exist, and it would soon be out of date if it did. Alternatively, one could rephrase the questions from the perspectives of providers and vendors. From the perspective of system purchasers, do the CPR systems that are available in the market meet the needs of health care institutions? And from the perspective of vendors, is the market ready to buy CPR systems? Although in neither case is the answer a resounding "yes," promising signs can be reported.

The CPR Market

One must be careful when describing a "CPR market" not to tether the concept to a single, static idea whose incarnation can be purchased "off-the-shelf." In some sense, it is precisely the static nature of the paper-based record that has been such a great burden to the practice of medicine. Instead, a CPR system is a constantly evolving concept whose value and function is expected to grow with the constantly changing demands of the health care environment and the improving technology upon which the system is built. The level of CPR development activity has definitely increased significantly since 1991. The number of commercial systems addressing various attributes of CPRs has increased and most major health care information technology vendors now offer CPR-related products. However, comprehensive information system products that seamlessly integrate data and coordinate processes across the entire continuum of health care services do not exist. Most health care information system vendors, whether their products were formerly based in the impatient or the outpatient side, are working to extend their products to cover the needs of integrated delivery systems. Developers generally start from the data end of the system and work toward the human side where the clinician interacts directly with the system. Hence, one way to trace the evolving functionality is to look at the transformation of data into information that clinicians use to make decisions. Although the path is not necessarily sequential, five hallmarks of this transformation are enumerated below:

  1. Integrated view of patient data,
  2. Access to knowledge resources,
  3. Physician order entry and clinician data entry,
  4. Integrated communications support, and
  5. Clinical decision support.
Integrated View of Patient Data

This is one of the earliest benefits of CPRs—improving access to all patient data whenever and wherever clinical decisions are made independent of where



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