Some health care provider institutions are well on their way toward developing new electronic approaches to patient records. This progress has been possible because of advances in computer technology and successful research on the application of such technology to medicine. These advances include, but are not limited to, hand-held computers; picture archiving and communications systems that permit electronic storage, transmission, and display of medical images; disk drives that offer mean time between failures of 60,000 or more hours; and high-speed telecommunications networks that can carry 1.7 billion characters per second over a 100-kilometer link. New technologies and applications such as these can potentially improve the quality of patient care, advance the scientific basis of medicine, moderate the costs of health care services, and enhance the education of health care professionals.
Computer-based patient records, as defined by the committee, could positively affect the quality of patient care in at least four ways. First, they offer a means of improving both the quality of and access to patient care data. Second, they allow providers to integrate information about patients over time and between settings of care. Third, they make medical knowledge more accessible for use by practitioners when needed. Fourth, they provide decision support to practitioners.
Research efforts could also benefit from computer-based patient record keeping in two key ways. First, improved data and access to those data would be available to researchers. Second, research findings could be communicated to practitioners through computer-based patient record systems
Computer-based patient records could assist efforts to moderate the costs of health care in three ways. First, improved information could reduce redundant tests and services that are performed in response to the unavailability of test results. Second, administrative costs could be reduced by electronic submission of claims and the ability to generate routine reports automatically. Third, the productivity of practitioners could be enhanced by (1) reducing the time needed to find missing records or to wait for records already in use; (2) reducing, if not eliminating, the need for redundant data entry; and (3) reducing the time needed to enter or review data in records that have been streamlined to eliminate unnecessary information.
Health care professionals not only encourage self-directed learning among their students (Gastel and Rogers, 1989) but are viewed as having a responsibility for continuing lifelong education (AAMC, 1984). Students thus require skills in organizing information and solving problems. Computer-based patient records can support information management and independent learning by health care students and professionals in both patient care and clinical research settings. Tools for such learning include clinical decision