(Weed, 1968). The summary time-oriented record (STOR) is an outpatient medical record system that consists of a concise summary of a patient's clinical data that can be used either in conjunction with the traditional medical record or by itself (Whiting-O'Keefe et al., 1985).

Problems with Access, Availability, and Retrieval

Record unavailability and difficulties in accessing records when they are available are frequent problems for patient record users (Pories, 1990). Tufo and Speidel (1971) documented in their study that medical records were unavailable in up to 30 percent of patient visits. They attributed this rate of unavailability to several possible causes: patients being seen in two or more clinics on the same day, charts not being forwarded, physicians keeping records in their offices or removing them from their offices, and records being misfiled in the file room. One hospital in the GAO study on automated medical records reported that it could not locate medical records 30 percent of the time (GAO, 1991). Even when records are readily available, the amount of time required to retrieve necessary information from a record can frustrate users (Fries, 1974; Zimmerman, 1978; Pories, 1990).

For researchers, access to paper records can be problematic and is generally resource intensive (Davies, 1990). Identifying records that contain needed data, retrieving needed records, reviewing records, collecting data, and entering data into data sets for analysis are time-consuming, expensive tasks. Yet access to existing computer-based records can also prove difficult for researchers because documentation on how to use systems may be lacking. Further, data aggregation can be hampered by lack of compatibility among systems.

Problems with Linkages and Integration

One of the major criticisms of the U.S. health care system is the discontinuity of care among providers (Rulin et al., 1988; Case and Jones, 1989). This discontinuity extends to patient records, whose lack of integration of inpatient and outpatient information is a significant deficiency. Paper patient records offer little hope of improving the coordination of health care services within or among provider institutions. Moreover, the inadequacy of patient record interfaces with other clinical data, administrative information, or medical knowledge impedes optimal use of record information in providing patient care. Several health care systems and institutions have developed records that overcome many of the problems associated with traditional paper records, but even these improved records suffer from their lack of easy transferability to other health care provider systems or institutions.

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