more innovative and more receptive to change than health care professionals in other types of settings.

Through the training of health care professionals (including continuing education), professional schools can both shape attitudes toward and provide the skills for using CPRs. Moreover, to the extent that professional schools influence the agenda of researchers (by providing space and support), they can foster the development of CPR systems. Some schools also now serve as centers of medical informatics training and of continuing research in medical informatics.

The NLM supports 11 institutions in efforts to develop prototypes of an Integrated Academic Information Management System (IAIMS). The objective of these projects is to ''develop the institutional information infrastructure that permits individuals to access information they need for their clinical or research work from any computer terminal wherever and whenever it is needed" (NAS, 1989). These projects may become models for linking the many departments of academic health and medical centers, including other departments in parent universities (e.g., economics, law, sociology) that have a role to play in clinical and health services research. IAIMS sites may also provide an infrastructure on which to base selected pilot CPR demonstration projects.

Two kinds of standard-setting organizations are potential CPR change agents. The first is those groups that are developing standards for health care information systems, primarily in the areas of communication protocols and the characteristics of information collection and use. Among these organizations are the Institute of Electrical and Electronics Engineers (IEEE), the American Society for Testing Materials (ASTM), and the International Standards Organization (ISO). The second kind of standard-setting group comprises various health care accreditation organizations, such as the Joint Commission on Accreditation of Healthcare Organizations, the National Committee on Quality Assurance, and the National League of Nursing. Their role may be to foster CPR development, acquisition, and use by setting standards for accreditation that are most effectively met through CPR systems.

CPR system vendors are likely to support development if the projected demand for CPR technology seems sufficient to recoup investment and marketing costs. As discussed earlier, however, vendors are uncertain about the willingness of health care providers to purchase CPR systems. Users or