several cases, however, the conflicts remained nettlesome and are discussed in Chapter 4 as particular challenges to future patient record development.

Second, at a technological frontier, customers may have difficulty expressing or even imagining a need. This situation may well occur with the computer-based patient record, which contains opportunities for functional characteristics that most users would not think to request. The pioneering designer must not only ask, "What do people want?" but also, "What would people want if they knew what could be done for them?"

Patient Record Functions

The traditional function of patient records has been to store information relevant to the care of a patient for subsequent retrieval. Patient record systems should offer users at least two additional functions. First, records should be able to guide the process of clinical problem solving. Second, records should support clinicians with decision analysis, reminders, risk assessment, and other "intelligent" features not available with paper records.


The attributes associated with the storage function are record access (i.e., availability, convenience, speed, and ease of use), quality, security, flexibility, connectivity, and efficiency.

ACCESS First and foremost, users want to retrieve information easily when and where they need it. Other features of a patient record system are essentially irrelevant to users if they cannot gain access to the system, to the records in the system, or to the data in the records.

Access can be described in terms of availability, convenience, reliability, 3 and ease of use. A patient record system should allow authorized clinical users convenient access to any record 24 hours a day. This requirement implies an adequate number of conveniently located terminals or work-stations, no system downtime, no lost records or data, and access to the record by more than one user at the same time. Nonclinical users typically require access to patient record data at least during standard working hours.

Different users need different levels and kinds of information (see Box 2-4). The ease with which users locate or retrieve needed data elements depends largely on the record format. Current paper record formats tend to segregate rather than integrate information; to facilitate communication of


System reliability refers to the constant availability of hardware and software needed for work in the clinical setting.

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