Even as patient care data become more voluminous and complex, the demand by multiple users for access to patient care data is increasing (Barnett, 1990). Information must be shared among the multiplicity of health care professionals who constitute the "health care team." These professionals represent the physician specialties, as well as nurses, dentists, therapists, pharmacists, technicians, social workers, and other health care providers. Patients may also require access to records; some providers advocate greater patient input into the process of care through patient identification of preferences among treatments, patient contributions to the record (particularly history and functional status; Davies and Ware, 1988; Donnelly, 1988; Tarlov et al., 1989), patient reading and validation of record data, and patient control and transport of pertinent parts of the record (Tufo et al., 1977; Bronson et al., 1978).
Administrators and managers of health care institutions require information to manage the quality of care provided and to allocate resources (e.g., labor, supplies, equipment, and facilities) according to the institution's patient case mix. Managers of provider institutions seek to link financial and patient care information to develop meaningful budgets, measure productivity and costs, and evaluate market position. Long-term institutional planning for personnel recruitment, equipment acquisition, and facilities development depends on anticipated trends in patient population needs.
Quality assurance activities constitute another information need. Such activities are a requirement for accreditation of hospitals by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); in addition, third-party payers carry out various quality monitoring and evaluation efforts. The best known is probably the Medicare peer review organization program administered by the Health Care Financing Administration (IOM, 1990c). Public and private third-party payers, medical professional societies, and researchers have been exploring practice guidelines and outcomes management as tools for improving care (IOM, 1990a,b). The risk management programs established by many health care institutions in response to the recent history of medical malpractice litigation add another level of information use (IOM, 1990c).
Patient care information to adjudicate claims for reimbursement made to third-party payers is an additional area of data needs. As expenditures related to health care have risen10 and as third-party payers have sought to