support systems, bibliographic and knowledge links (including links to clinical practice guidelines), and statistical software.
Meeting the challenge of managing health care information depends on more than technological advances. The usefulness of any technology depends on how well it and its progeny are applied. In addition to technology, a study of the improvement of patient records must address how the use of those records might be improved, a question that raises potentially sensitive issues.15 "Improving records" and "improving clinical reasoning" are topics inevitably connected to one another because ideally the record reflects the clinical reasoning process. If better record systems are to be created in the future, the user must be recognized as part of the system, and the problem solving activities of practitioners must be examined.
In addition to technological and behavioral opportunities for improving patient records, certain strategic issues must be addressed. Other information-intensive industries (e.g., banking) have successfully implemented widespread computer-based information management technologies. Understanding the factors that have slowed the development and diffusion of such technologies in health care is a first step toward achieving more rapid advances in the future.
Many attempts have been made over the years to advance clinical computing, to reform the patient record, and to encourage health care professionals to maintain the record more conscientiously (e.g., by entering necessary clinical data). Why should or how could renewed efforts to establish the routine use of new computer-based record systems succeed now when previous attempts have failed? Why might this report have a significant impact?
The committee believes that five conditions of the environment in which its strategic plan might be implemented increase the likelihood of achieving widespread use of computer-based patient records. First, current demands for patient information throughout the health care sector will not diminish; indeed, they will probably increase. Second, technologies essential to computer-based patient records are becoming more powerful and less expensive