Pave the way for computer-based patient records

There is increasing interest in the adoption of computer-based patient record (CPR) systems. Starting with the publication of the Institute of Medicine's 1999 report, "To Err Is Human: Building a Safer Health System," closely followed by "Crossing the Quality Chasm: A New Health System for the 21st Century," the focus is now on the systemic changes that can lead to improved quality of care delivered by the U.S. healthcare system. Furthermore, the past nine months have seen an executive order calling for widespread adoption of clinical information systems within 10 years, and the appointment of Dr. David Brailer as the national coordinator for health information technology. Attention is finally being paid to how technology can help solve the problems within healthcare.

Estimates indicate that poor clinical management accounts for as much as one-third of healthcare costs. The aging population will only make things worse. According to figures from the United Nations, the percentage of world population over age 60 is expected to rise from 15% in 1980 to more than 33% over the next half century. This population accounts for nearly five times more healthcare costs than any other group.

The potential has never been so high for computers to provide tangible improvements in the safety and efficacy of healthcare. For many years, healthcare information technology has been making incremental advances in its ability to support clinical activities. This incremental progress has continued, but the aggregate impact has been to enable a revolution in the ability of healthcare automation systems to support the clinical care processes. As a result, CPR systems installed in provider organizations in 2005 or later will have a revolutionary impact on the clinical capabilities of those institutions.

Only the use of a CPR will permit a provider organization to have adequate control over its clinical processes, achieve needed clinical efficiencies, eliminate the vast majority of clinical errors, and implement the continual process improvements demanded by the practice of evidence-based medicine. The limitations preventing the achievement of these goals are no longer technological. Rather, the situation is limited largely by the imagination of vendors to create more appropriate clinical applications and by provider organizations to apply these applications to their unique clinical situations.

Despite the ability of CPR systems to improve health status, clinical workflow, and communication among providers-as well as eliminate overuse, underuse, and misuse of drugs, tests and healthcare services in general-less than 10% of physician practices and healthcare organizations have implemented one. Recent studies show that resource availability is the single largest barrier to CPR adoption.

Only a minority of plans have taken steps to promote physician adoption of these systems. Health plans need to recognize that CPR systems can lead to the significant economic benefits of appropriate utilization, fewer redundancies and reduced complications. More plans need to follow the lead of the innovators and support hospital and physician investment in CPR adoption by creating subsidies or other economic offsets.

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