Future patient records will provide new dimensions of record functionality through links to other databases, decision support tools, and reliable transmission of detailed information across substantial distances. To meet the needs of practitioners, future patient record systems will be linked to knowledge bases, clinical decision support systems, statistical software packages, and video or picture graphics. In hospitals, various departmental systems (e.g., finance, laboratory, nursing, radiology) will be able to communicate with the patient record system. Physician offices will be able to communicate with local hospitals and with national bibliographic resources such as MEDLINE. In the larger health care environment, computer-based information management systems will be able to communicate with information systems of provider institutions, third-party payers, and other health care entities.

As noted in the committee's definition of a patient record system, people are also a system component. Optimal functioning of future systems poses four conditions for users. First, they must have confidence in the data (which implies that data must be entered directly by the practitioner who collected it, reliably integrated among all sources, and accurately retrieved whenever needed). Second, they must use the record actively in the clinical process. Third, they must understand that the record is a resource for studying the effectiveness and efficiency of clinical processes, procedures, and technologies. Fourth, they must be capable of using future computer-based record systems efficiently.

The committee visualizes the CPR as the core of health care information systems. Figure 2-1 illustrates the various types of interactions in which CPR systems will be required to engage. Such systems must be able to transmit data to other types of clinical and administrative information systems within provider institutions; they must also be able to transmit data to other provider institutions or to secondary databases. (For example, CPR systems in physicians' offices should be able to communicate with local hospitals.) In addition, CPR systems must also be able to accept data from other internal and external computer-based systems.

Figure 2-2 illustrates the committee's vision of a national health care information system. Such a system would support the transmission of data for clinical purposes and, with appropriate confidentiality measures, for reimbursement and research purposes. It would also bring information resources (e.g., MEDLINE) to virtually all practitioners. A national health care information system would require that local, regional, and national networks be established. These networks would provide the means to transmit a laboratory report from a hospital to a physician's office or to send a patient record across the country. A national health care information system with these and other capabilities could support the coordination and integration of health care services across settings and among providers of care.

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