Computer-based patient records and the systems in which they function are becoming an essential technology for health care in part because the information management challenges faced by health care professionals are increasing daily. Technological progress makes it possible for CPRs and CPR systems to provide total, cost-effective access to more complete, accurate patient care data and to offer improved performance and enhanced functions that can be used to meet those information management challenges. CPRs can play an important role in improving the quality of patient care and strengthening the scientific basis of clinical practice; they can also contribute to the management and moderation of health care costs.

A research by the Institute of Medicine (IOM) study committee shows that the time is right for a major initiative to make CPRs a standard technology in health care within a decade. Achieving this goal within 10 years will require a nationwide effort and a great deal of work. More research and development are needed in several critical areas to ensure that systems meet the needs of patients, practitioners, administrators, third-party payers, researchers, and policymakers. For example, the need to protect patient privacy must be balanced by the need for timely access to data at multiple sites. Systems must offer both considerable flexibility for users and standards required for data transfer and exchange.

CPR implementation will necessitate both organizational and behavioral changes. Organizationally, it will require substantial coordination across the many elements of the pluralistic U.S. health care system. Behaviorally, it will demand that users develop new skills to use CPR systems and to change their documentation behaviors.

Conclusions

Patient records are the primary repository of data in the information-intensive health care industry. Although clinical information is increasingly likely to be computerized, the current, predominant mode for recording patient care data remains the paper record. Paper records have the advantages of being familiar to users and portable; when they are not too large, users can readily browse through them. Paper records, however, have serious, overriding limitations that frequently frustrate users and perpetuate inefficiencies in the health care system. Further, the impact of these limitations is growing as the health care system becomes more complex. Modern patient care requirements have outgrown the paper record.