Several other capabilities are needed for optimal access. Users should be able to display information at different levels of detail. Moreover, the system should permit virtually every data item to be used as a key for retrieval and should also enable users to access subsets of data. All users, regardless of their level of computer expertise, should be able to enter most queries without the intervention of a programmer; thus, an English-like retrieval language should be part of the system.
Accessing information when needed includes more than finding an available terminal; from the user's point of view, it means an adequate (i.e., fast) system response time. Users want to perform their tasks at least as fast as they currently perform them with paper records. Extremely rapid retrieval of information, measured in fractions of a second, is an essential function for primary users of the CPR. In addition, clinicians, who are accustomed to writing or dictating their entries to patient records, want a comparable method in the CPR system to add data to the record.
From the users' perspective, the difficulty involved in learning to use a system also affects access. Thus, operation of patient record systems should require only minimal training.4 Training for physicians in particular should be short and easy, preferably occurring "on line" and at their convenience. Many physicians are unwilling to devote large blocks of time to learning a new record system, even if ultimately it might make their work easier. In addition, built-in, displayable "help" documentation on system operation and the data elements should be available to both clinical and nonclinical users.
The question of patient access to records is debated among practitioners. It is likely, however, that the trend toward increasing patient access will continue. Some providers consider it appropriate for patients to enter data (e.g., historical medical information) into their records routinely. Recently, functional status and preferences among various treatments have been identified as data that could be recorded by patients to assist practitioners in developing care plans.
Some practitioners encourage patients to audit their records for accuracy and completeness; they may also use the record for patient education. Indeed, as patients become increasingly computer-literate, knowledge-seeking consumers of health care services, the CPR may function as an important patient education tool by offering patients access to resources such as MEDLINE.
This statement assumes that record users will receive adequate training in how to use patient records and the other functions provided by patient record systems through formal education (i.e., professional schools and continuing education). It also refers to the requirement that users who work in more than one provider setting (e.g., physician office and hospital) be able to learn multiple patient record systems easily.