These projects could benefit greatly from a capacity to acquire large amounts of information, locate those data securely in a single site (for analysis and archival purposes), and make them available to properly authorized users for analysis (and perhaps for clinical purposes as well). The collection, storage, maintenance, and use of such information through computer-based systems, rather than through paper records (or paper records secondarily data-entered into computer files), can be expected over the long run to promote more comprehensive and more productive special projects on this and other complex topics (e.g., services to children with serious impairments and handicaps such as spina bifida, debilitating chronic illnesses, or cleft lip and palate).

The fifth point relates more specifically to the potential value of communication and collaboration across federal agencies. Several federal departments have already taken steps to design and implement one or more components of a CPR system. Notable among these are the Departments of Defense (DoD) and Veterans Affairs (VA). Both departments have health care delivery responsibilities for distinct, and sometimes quite dispersed, populations that have both traditional primary care needs (e.g., for screening and prevention) and health care problems at least equivalent in complexity and severity to those facing disadvantaged MCH populations. Both departments also have considerable health research programs. Lessons from their efforts to date may prove helpful in planning computer-based systems to serve MCH needs; conversely, issues that arise in planning for and delivering services to disadvantaged MCH populations might be posed to DoD and the VA as a means of bringing difficult technical questions to their attention.

In addition, the Health Care Financing Administration (HCFA) has mounted an interesting effort to develop a ''uniform clinical data set"; although it is oriented toward hospital care (and care for the elderly), its developmental history to date offers useful and perhaps cautionary lessons for others attempting to develop clinical data sets and data dictionaries. Certainly it would be important for HCFA developers to understand the special needs and perspectives of a computer-based data set oriented more toward Medicaid than toward Medicare.

Finally, the Agency for Health Care Policy and Research (AHCPR) has a specific congressional mandate to work toward the development of computer databases that will serve broad clinical evaluation purposes. Part of AHCPR's interest has been specifically in computer-based record systems, including the potential for a public, or public-private, entity to undertake many technical, legal, and other tasks related to the establishment of CPRs and CPR systems nationally over the next decade. Because the MCH component of HRSA will have wide concerns about quality of care, outcomes of care, and similar issues, it would seem prudent for HRSA to work together from the outset with a sister Public Health Service agency on many of these subjects.



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