development and implementation by participating in planning and by influencing their peers.

Professional associations for physicians, nurses, dentists, social workers, physical therapists, and similar kinds of health care practitioners are all vehicles by which to provide ongoing education to their members about the benefits and liabilities of CPRs. Associations such as the American College of Physicians, American College of Surgeons, American Dental Association, American Hospital Association, American Medical Association, American Medical Record Association, American Nurses Association, and Group Health Association of America are among the societies that could implement formal CPR education and awareness programs as part of their membership mailings and annual meetings. Many already have active committees to deal with medical informatics issues.

These and similar associations are likely to voice the concerns of their members, but they are also in a position to influence their members. Depending on how they weigh the advantages and disadvantages of CPR activities, they can lobby for or against them. To the extent that professional organizations see more benefits than liabilities in CPR implementation, they can be valuable participants in future consensus-building activities.

Patients and Representatives of Patients

As discussed earlier, the question of ensuring privacy and confidentiality has been identified as one of the crucial hurdles to effective CPR implementation. Given patient concerns about privacy and the potential for CPR systems to increase information flow within and outside of health care provider settings, patients may distrust CPR systems. Furthermore, patients are no more likely than health care professionals to use or understand computers, let alone computer-based record systems.

Survey data suggest that Americans view the nation's health care system as poorly organized and inefficient; most believe that rising health care costs can be reduced without cutting the quality of care (Blendon, 1988). As noted elsewhere in this report, CPRs and CPR systems offer many advantages (compared with current paper records) for overcoming some of these inefficiencies and improving health care quality. Hence, patients may have some basis for supporting the implementation of CPR systems.

Any influence of individual patients on CPR efforts is likely to be indirect at best. Patients might, for example, select providers on the basis of the provider's use of a CPR system. Greater influence can be exerted by the various voluntary membership organizations that represent the concerns of particular patient groups (e.g., the American Diabetes Association) or those of specific population groups (e.g., the American Association of Retired Persons). These organizations have the capacity to acquire a broad



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