Index

A

Academic research, 8, 112, 114, 150, 159

Access issues, 62, 67, 74, 80, 81-83, 136, 179, 181

computer technology and, 4, 68, 101

insurers, 80, 209, 210

knowledge resources, 7

legal right to, 14, 83, 209-210, 214-216, 217-218

patient records, 6-7, 63

software source code, 220

system redundancy, fault tolerance, 118, 119

system response, 83, 106, 120, 126, 145-146, 220

see also Confidentiality

Accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218

Accredited Standards Committee, 13

Accuracy issues, 95, 110, 127, 207, 219

see also Errors and error analysis

Acute disorders and care, 66, 123-124, 131

Administrative functions, 46, 47, 51, 65, 89, 93, 95, 121, 181, 195

access to, 7, 21-22

billing, 64, 78, 106, 120

costs, 46, 51, 68, 98, 193

standards, 13

Advocacy, patients, 153-154

Agency for Health Care Policy and Research, 9, 66-67, 155, 164, 166 , 167, 175, 184, 185

AIDS, 215

Ambulatory care records, see Outpatient records

American College of Radiologists, 13, 108

American Health Information Management Association, 14

American Medical Society, 67, 206

American Society for Testing and Materials, 13, 108

Arden syntax, 14, 125

ARPANET, 4

Artificial intelligence, 201, 223

see also Knowledge-based systems

Attitudes

toward diffusion of innovations, 142, 143-144, 145, 152

public, 153, 195

systems vendors, 135-137

B

Bibliographic databases, 47, 69, 74, 92-93, 95, 119, 124, 181

Billing, 64, 78, 106, 120

Browser software, 4-5



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--> Index A Academic research, 8, 112, 114, 150, 159 Access issues, 62, 67, 74, 80, 81-83, 136, 179, 181 computer technology and, 4, 68, 101 insurers, 80, 209, 210 knowledge resources, 7 legal right to, 14, 83, 209-210, 214-216, 217-218 patient records, 6-7, 63 software source code, 220 system redundancy, fault tolerance, 118, 119 system response, 83, 106, 120, 126, 145-146, 220 see also Confidentiality Accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218 Accredited Standards Committee, 13 Accuracy issues, 95, 110, 127, 207, 219 see also Errors and error analysis Acute disorders and care, 66, 123-124, 131 Administrative functions, 46, 47, 51, 65, 89, 93, 95, 121, 181, 195 access to, 7, 21-22 billing, 64, 78, 106, 120 costs, 46, 51, 68, 98, 193 standards, 13 Advocacy, patients, 153-154 Agency for Health Care Policy and Research, 9, 66-67, 155, 164, 166 , 167, 175, 184, 185 AIDS, 215 Ambulatory care records, see Outpatient records American College of Radiologists, 13, 108 American Health Information Management Association, 14 American Medical Society, 67, 206 American Society for Testing and Materials, 13, 108 Arden syntax, 14, 125 ARPANET, 4 Artificial intelligence, 201, 223 see also Knowledge-based systems Attitudes toward diffusion of innovations, 142, 143-144, 145, 152 public, 153, 195 systems vendors, 135-137 B Bibliographic databases, 47, 69, 74, 92-93, 95, 119, 124, 181 Billing, 64, 78, 106, 120 Browser software, 4-5

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--> C Case studies hospital information systems, 119-120 maternal and child health care, 173-175 Centers for Disease Control, 155-156, 185 Change agents, 151-161, 163, 166, 168-169, 183, 184 Chart Checker, 123-124 Chronic diseases, general, 46, 64, 66 Clinical practice guidelines, 2, 9, 51, 67, 98, 164, 181, 190 Clinical processes and systems, 47, 48, 56, 66-67, 85, 100-101, 121-126 decision support/problem solving, 7, 51, 53, 55, 61-62, 63-64, 68-69, 74, 81, 84, 90-93, 95, 105, 112, 117, 124-125, 136, 149, 181, 223 department-level information systems, 112, 113, 136 historical perspectives, 111-113 knowledge-based system, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 laboratory tests, 64, 116, 123 linkages, 6, 88 Classification, see Standards: data exchange and vocabulary Coding standards for data elements, 13-14, 25, 39 Common Object Request Broker Architecture, 31 Composite Health Care System, 121 Computer-based Patient Record Institute, 10, 14, 50, 167, 168, 177 , 182, 183-185, 187, 188, 189, 191-195 Davies CPR Recognition Program, 8, 16 Computer-Stored Ambulatory System Record Systems (COSTAR), 112, 115-117 Computers at Risk: Safe Computing in the Information Age, 189 Confidentiality, 46, 47, 48, 67, 82, 80, 86-87, 95, 147-148, 153, 169, 181, 188, 192, 200, 207, 208-209, 214-216, 221-222 contract provisions, 221 design for, 14-15, 40, 139 European systems, 37-38 future systems, 94 individual practitioners' patient records, 57, 67 insurer access and, 80, 209, 210 Internet and, 4 pharmacy records, 57 privacy defined, 67 secondary databases, 110 standards, 13, 40, 131, 188 state law, 147-148, 208-209 technological aspects, 110, 126, 127-129 Communications infrastructure, 7-8 see also Networks; Telecommunications Connectivity, see Linkage and integration Content issues, 59, 60-61, 80 definition of, 163, 183 outpatient records, 63 standards, 63, 140, 187 tables of, in computerized records, 82 Contracts, 200-201, 219-221 Coordination, see Organizational factors Coordination and Continuity in Health Care (CoCo) project, 32, 33-34 COSTAR, 112, 115-117 Cost factors, 46, 49, 53, 58, 66, 68, 89, 93, 153, 154, 158, 161, 169-170, 178, 179, 181, 182, 186, 189-190 administrative, 46, 51, 68, 98, 193 clerical, 123, 141 computing technology, 7, 15-16, 69-70, 105-106, 112, 126, 127, 136 , 137, 141, 146 containment issues, 1-2, 15-16, 26, 35 data entry, 7, 84, 89, 126 demonstration projects, 157 design and development aspects, 15, 139, 140-142, 164 diffusion of technology, 145-146 hospital systems, 53, 63, 64, 137, 141 insurers, 65-66, 145, 154, 194 malpractice insurance, 124 maternal and child health care program, 156 medical information systems, 141, 146 per patient, 53, 145 secondary databases, 50, 110, 177, 193 sharing, 50, 51, 165-168, 177, 183, 193-194, 196 standards, 146 technological innovations, general, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 voice recognition, 127 Council on Ethical and Judicial Affairs of the American Medical Association , 206 Court cases, see Litigation

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--> D Database management systems, 101, 103-104, 179 specific, 111-125 Databases, 50, 101-103, 148, 150, 179 AMA guidelines, 206 bibliographic, 47, 69, 74, 92-93, 95, 119, 124, 181 federal role, 67 linkage of, 49, 69, 88, 89, 95, 105, 106-107, 110-111, 124; see also Networks prescription drug, 36-37 problem-oriented medical record, 91 query languages, 106, 117 secondary, 49, 50, 55-56, 69, 74, 95, 77-78, 98, 110-111, 124, 161 , 163, 177, 179, 181, 182, 183, 191-193 specific, 111-125 see also Knowledge-based systems Data entry, 117-118, 122, 125-126, 136, 137, 186 approaches, 29-32 cost factors, 84, 89, 126 errors, 84, 89, 105 physician orders, 2, 7, 25, 29-32, 126, 145, 168, 186 transcription, 25 voice recognition, 29, 106, 126-127, 131, 179, 186 Data quality, 84-86 Data retrieval, 47, 48, 53, 105-106, 111, 179, 181 Data storage, general, 81-90, 111 Decentralized Hospital Computer Program, 120-121 Decision support and problem solving, 51, 53, 55, 61-62, 63-64, 68 -69, 74, 81, 84, 90-93, 95, 105, 112, 117, 124-125, 136, 149, 181, 223 alerts, 8 knowledge-based systems, 12, 14, 74, 88, 92, 95, 105, 110, 119, 124 -125, 181 status in U.S., 8, 12, 14 Defense Advanced Research Projects Agency (DARPA), 150 Definitional issues, 55-56, 90, 95, 163, 183 change agents versus stakeholders, 151, 184 computer-based patient record, 9, 10-11, 13, 55, 95, 135-136, 139 contract law, 219 data integrity, 86-87 development versus diffusion, 138 health care needs, 74-79 hearsay, evidence, 212 patient records, 55, 95, 135-136, 139 privacy, 67 users, 75 Demographic factors, 46, 64, 66, 70, 116, 173-174, 195 see also Epidemiology Demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 Department-level information systems, hospitals, 112, 113, 136 Department of Defense, 10, 121, 129-130, 141, 150, 157, 165, 166, 175 Department of Energy, 150 Department of Health and Human Services, 155, 164, 167, 185 see also specific subordinate agencies Department of Veterans Affairs, 8, 120-121, 129-130, 141, 157-158, 165, 166, 175 Design and development, 49, 51, 67, 100, 138-142, 151-169, 182, 185 barriers to, 23, 40 costs, 139, 140-142, 164 defined, 138 modular, 116, 120-121, 124-125 problem-oriented medical record, 91 status, in U.S., 6-8, 12, 40 for system phasing, 93 user interfaces, 12 Diabcards, 34 Dictionaries, see Vocabulary control Diffusion, innovations, 23-25, 45, 48-49, 69, 139, 142-151, 169, 182 attitudes, 142, 143-144, 145, 152 costs, 145-146 defined, 138 insurers, 143, 145, 146, 154-155 see also Education and training; Professional education DIOGENE, 122, 127 Drugs, see Pharmacies and pharmaceuticals E Early Clinical Information System, 120 Economic issues physician incentives, data entry, 126, 145, 168, 186

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--> productivity, 46, 68, 94, 154, 193 see also Cost factors; Financial factors; Funding Education and training, 49, 51, 67 change agents and stakeholders, 163, 183 diffusion of innovations, general, 142, 143-145, 146, 161 patient, 75, 83 users, general, 49, 83, 143-145 see also Professional education Efficiency/effectiveness, 53, 58, 66, 67, 89-90, 95, 127, 161, 163 , 167, 179 system response time, 83, 106, 120, 126, 145-146, 220 Electrocardiogram interpretation system, 27 Electronic Data Interchange for Finance, Administration, Commerce, and Trade (EDIFACT), 31, 33 Electronic mail, 33, 47, 119, 150, 189 Emergency care, see Acute disorders and care Employers and employment, 66, 154-155 Encounter-oriented medical records, 115 Epidemiology, 88, 127 national, 66, 155, 174 risk factors, 66, 84, 93 Errors and error analysis, 219 data entry, 84, 89, 105 on-line, 90, 105 voice recognition, 127 see also Accuracy issues European CPR in hospitals, 26-32 in primary care, 23-26 privacy and confidentiality, 37-38 security, 39 for shared care, 32-34, 38 standardization, 38-39 status, general, 21-23 treatment protocols integrated with, 36-37 uses of data, 34-35 Evaluation, 75, 182 computer applications costs, 141 data validity tags, 87 of patient care, defined, 56 peer review, 65, 157 reliability of records, 59, 81, 109-110 see also Efficiency/effectiveness Event-oriented medical records, 117 Exmouth Project, 122-123 Expert systems, see Knowledge-based systems F Federal government, 50, 65, 66-67, 120-121, 155-158, 161, 164-168, 173-175, 184-185 Computer-based Patient Record Institute, 8, 10, 14, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cooperation with public sector, 131, 165-168, 182, 184, 185 funding, 50, 155, 164-168, 184-185 interagency coordination, general, 175, 184, 185 national information system, 9-10, 50, 95-98, 166-168, 169, 173, 174, 177, 182-185, 189 organizational role, general, 66-67, 175, 184, 185 research, 67, 155, 164-165, 174, 175 standards, 66, 67, 129-131, 155, 161 see also Laws, specific federal Federal Networking Council, 150, 189 Federal Privacy Act, 208 Financial factors, 46, 49, 51, 65, 82, 98, 119-120 federal role, 65, 66-67 see also Billing; Cost factors; Funding; Insurance and insurers, health Flexibility, 87, 113, 137, 179, 181 Flow sheets, 61 Food and Drug Administration, 148-149, 185, 189 Format issues, records, 59, 61-62, 80, 90-91, 115 European, 38-39 outpatient records, 63 problem-oriented, 61-62, 90-91, 93, 115, 117, 124 standards, 12-14, 23, 38-39, 63, 140, 186, 191 tables of contents/indexes, 82 Foundations, 161, 163, 185, 189 Framework Programs on Research and Development of the European Union , 21, 23 France, 29, 36 Funding, 49, 50, 143, 155, 161, 165, 174, 177, 179, 182, 184-185 federal, 50, 155, 164-168, 184-185 hospital systems, 141 standards development, 129

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--> G General Accounting Office, 52-53, 141, 167-168 General practitioners, 23-26, 33 Germany, 34 Government role, see Federal government; State governments; and specific departments and agencies Graphics, 32, 47, 93, 95, 104, 105-106, 150, 179 picture archiving and communication system, 27 windowing, 117, 137 see also Images and image processing Group practices, 114-115 H Harvard Community Health Plan, 112, 115-117 Harvard Medical School, 119 HEALTH, 155 Health Care Financing Administration, 65, 129-130, 131, 156-157, 164-165, 166, 175, 185, 207 Health care system, structure of, 1-5, 22, 26, 142-143, 179 Health Evaluation through Logical Processing (HELP), 112, 118-119, 125, 127 Health maintenance organizations, 115-117 Health Plan Employer Data and Information Set (HEDIS), 3 Health Resources and Services Administration, 156, 173-174, 175, 185 Hearsay, evidence, 212-214 High-Performance Computing Act, 150 High-Performance Computing and Communications contracts, 9 Historical perspectives, 48, 52, 56-57, 111-113 committee study, 53-55 COSTAR, 112, 115-117 hospital systems, 111, 141 networks, 150 THERESA, 112, 117-118 HL 51 standards, 108 Hospital systems, 82, 89, 111, 117-121, 136 costs, 53, 63, 64, 137, 141 defined, 56 department-level information systems, 112, 113, 136 European, 26-32 historical perspectives, 111, 141 licensure laws, 147, 201-205, 217 multi-institution, 68, 88, 120-121, 141, 157, 165 THERESA, 112, 117-118, 127 Human-computer interface, see Users Hypertext markup language (HTML), 5 Hypertext transfer protocol (HTTP), 5 I Images and image processing, 13, 31, 39, 64, 68, 104, 106, 107, 114 -115, 150, 179, 189 see also Graphics Indexes, 82 Information Security Foundation, 189 Insurance and insurers, health, 47, 50, 65-66, 75, 77, 78, 158, 169 -170, 177, 194 confidentiality and access by, 80, 209, 210 contract provisions, 221 cost factors, 65-66, 145, 154, 194 diffusion of innovation and, 143, 145, 146, 154-155 electronic claims submission, 89 employer provided, 154-155 health maintenance organizations, 115-117 physician incentives, data entry, 145, 168 smart cards, 34 see also Medicaid; Medicare Insurance Information and Privacy Protection Model Act, 210 Insurance, malpractice, 124 Institute of Electronic and Electrical Engineers, 13, 187 Institute of Medicine, 45, 53-54, 59, 67, 135, 158, 176, 195 Integrated Academic Information Management System, 160 Integrated delivery system (IDS), 3, 4, 6, 15-16 Integrated Services Digital Network, 109 Intellectual property, 220 Intelligence, 49, 80, 81 artificial intelligence, 201, 223 see also Knowledge-based systems Intermountain Health Care Corporation, 118 International Classification for Primary Care, 25 International programs and activities, 21-40, 122-123, 139, 187-188 Internet, 4, 12, 150 see also World Wide Web Intranet, 5

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--> J Joint Commission on Accreditation of Healthcare Organizations, 65, 160, 165, 208, 214, 217, 218 K Knowledge-based systems, 28, 31-32, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 Knowledge resources, access to, 7 L Laboratory tests, 64, 116, 123 Laws, specific federal Federal Privacy Act, 208 High-Performance Computing Act, 150 Insurance Portability and Accountability Act of 1996, 13, 14 Omnibus Budget Reconciliation Act, 66-67, 157 Social Security Act, 173, 174 Uniform Health-Care Information Act, 192, 210, 222 Leadership issues, 8, 14, 16-17 Legacy systems, 27, 31 Legal issues, 49, 142, 147-149, 161, 182, 183, 192-193, 200-223 contracts, 200-201, 219-221 evidentiary, 211-214 licensure laws, 147, 192, 200, 201-206, 220, 221-222 information access, right to, 83, 209-210, 214-216, 217-218; see also Confidentiality intellectual property, 14, 220 malpractice, 124, 144 ownership of data, 14, 147, 192, 211, 220 systems defect liability, 149, 200 vendors, 149, 200-201, 202, 219-221 viruses, computer, 217, 222 see also Laws, specific federal; Litigation; Regulations Legislation, 90 model, 50, 192-193, 210, 221-222 see also Laws, specific federal Licensure laws, 147, 192, 200, 201-206, 220 national, 221-222 Linkage and integration, 47, 62, 80, 87-89, 95, 181 confidentiality and, 147 of databases, 49, 69, 88, 89, 95, 105, 106-107, 110-111, 124, 179, 181; see also Secondary databases development and diffusion resources, 49, 51 financial-care information, 65 14C project, 28-29, 30-31 multi-site care, 32-34, 68, 88, 120-121 platforms, European, 27-28 unique health identifiers, 13 see also Internet; Organizational factors Litigation, 65, 79 contracts, 219 evidentiary issues, 211-214 systems defect liability, 149, 200 Lockheed Corporation, 120 Longitudinal approaches, 66 institutional planning, 65 patient records, 37, 47, 48, 61, 66, 68, 174 M Malcolm Baldrige Quality Award Program, 16 Malpractice, 124, 144 Managed care, 2, 7, 26 Management of care, general, 65, 78, 93, 94; see also Administrative functions Maternal and child health care program, 156, 173-175 Medicaid, 157, 174, 206 Medical information systems, 111 access to, 7 costs, 141, 146 defined, 56 Medical Logic Modules, 124-125 The Medical Record (TMR), 114-115 Medicare, 156-157, 158, 165 peer review, 65, 157 regulations, 206-208, 214, 217 Medix, standards, 108 MEDLARS, 155 MEDLINE, 124, 155 MILNET, 150 Modular design, 116, 120-121, 124-125 Multimedia records, 11

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--> N National Aeronautics and Space Administration, 150 National Association of Insurance Commissioners, 210 National Committee for Quality Assurance, 3 National Committee on Vital and Health Statistics, 14 National Conference of Commissioners on Uniform State Laws, 148 National Electrical Manufacturers Association, 108 National Institute of Standards and Testing, 10 National Institutes of Health, 53, 155 National Library of Medicine, 9, 13, 124, 155, 160, 166 National Research and Education Network, 150-151, 189 National Research Council, 54 National Science Foundation, 150 Natural language processing, 29-31 Netherlands, The, 23-24, 26, 29, 36, 37 Networks, 5, 49, 51, 68, 95, 109, 150, 186, 189 design for, 139 diffusion of innovations, 142, 149-151 electronic mail, 47, 119, 150, 189 European, 22-23, 26-27, 32 national information systems, 9, 50, 95-98, 150-151, 163, 166-168, 169, 173, 174, 177, 182-185, 189 security, 4, 88, 96, 148, 216 for shared care, 32-34, 38 standards, data exchange and vocabulary, 5, 9, 12-14, 27, 39, 48, 50, 51, 85-86, 96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 Nurses, chart writing, time spent, 63 O Office of Technology Assessment, 141 Omnibus Budget Reconciliation Act, 66-67, 157 ORCA, 28 Organizational factors, 49-50, 51, 52, 162-168, 176, 179-180, 182-183 accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218 change agents and stakeholders, 151-161, 163, 166, 168-169, 179, 183, 184 Computer-based Patient Record Institute, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cost sharing, 50, 51, 165-168, 177, 183, 193-194, 196 federal interagency coordination, 175, 184, 185 federal role, general, 66-67, 175, 184, 185 health care system, general structure, 1-5, 22, 26, 40, 142-143, 179 institutional planning, 65, 136 medical record practices, physicians, 59, 61, 63 private/public cooperation, 131, 165-168, 182, 184, 185 professional associations, 50, 65, 67, 143, 153, 160, 165, 168, 179-181, 194, 206, 208, 210, 214, 217, 218 standard-setting organization, 170 technological innovation, 138, 151-161, 168-169 see also Administrative functions; Format issues, records; Linkage and integration; Management of care, general Outcomes reporting requirements, 3 Outpatient records, 63, 112, 141 COSTAR, 112, 115-117 summary time-oriented record, 62 Ownership issues, 147, 192, 211, 220 P PaperChase, 119 Paper records, 57-63, 81, 84, 90, 178 Patient record, general, 56-57 defined, 55, 95, 135-136, 139 paper, 57-63, 81, 84, 90, 178 patient-derived information, 11 transcription, 25 users and uses, 29, 34-35, 75-78 Patients, general, 153-154 access to information, legal right, 83, 209-210, 214-216, 217-218 cost per, 53, 145 as data users, 65, 83 education, 75, 83 see also Confidentiality Peer review, 65, 157 personal computers, 123, 124

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--> Personal identification numbers, 148 Pharmacies and pharmaceuticals, 13, 25, 26, 34, 36, 39, 57, 64, 157 Physician Payment Review Commission, 158 Physicians, 47, 64, 87, 114-115 confidentiality, 57, 67 critiquing systems, 34, 35 diffusion of innovations, 23-25, 26, 144 group practices, 114-115 managers, relationship, 93 medical record practices, 59, 61, 63 order entry, 7, 25, 29-32, 126, 145, 168, 186 personal computer system, England, 123 time factors, 63, 83 Physicians' Desk Reference, 119 Policy development, 77, 79, 82 politics, 46, 48-49, 195 public opinion, 153, 195 Population-based care, 26 Population dynamics, see Demographic factors Poverty, 156 maternal and child health care, 156, 173-175 Medicaid, 157, 174, 206 Primary care, CPR in, 2, 23-26 Primary patient record, general, 77, 78 defined, 55 Privacy, see Confidentiality Private sector, 50, 79, 129, 165-166, 168, 177 cooperation with public sector, 50, 131 165-168, 177, 182, 184, 185 employers, 154-155 foundations, 161, 163, 185, 189 information system vendors, 100, 135-137, 149, 160-161, 162, 169, 185, 200-201, 202, 219-221 see also Insurance and insurers, health; Professional associations and societies Problem-knowledge coupler, 124 Problem-oriented medical record (POMR), 61-62, 90-91, 93, 115, 117 , 124 Problem solving, see Decision support and problem solving Productivity health professionals, 46, 68, 94, 193 insurers and, 154 Professional associations and societies, 50, 65, 143, 153, 168, 179 -181, 194, 210 AMA, 67, 206 JCAHO, 65, 160, 165, 208, 214, 217, 218 Professional education, 50, 68-69, 75, 77, 79, 92-93, 159-160, 168 , 169, 177, 182, 183, 194-195 academic research, 112, 114, 150, 159 diffusion of innovations, 142, 143-145, 146, 161 European, 25 physicians, 25, 83 teaching hospitals, 82 Professionals, general, 50, 51, 76, 152-153, 168, 178, 180-181 licensure laws, 206 productivity, 46, 68, 94, 193 see also Nurses; Physicians; Users Projections, 56, 94-98, 181 digital switching, 109 imaging, 107 text processing systems, 106 Prospective Payment Assessment Commission, 158 Protocols, treatment, integration of, 34, 36-37 Prototypes, see Demonstration projects Public Health Service, 66, 175, 185 Public opinion, 153, 195 Q Quality control, 75, 77, 84-86, 186, 190-191 accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218 of care, 3, 7, 17, 34, 35, 46, 51, 64, 68, 93, 94, 123, 145, 153, 154, 158, 178, 181, 190-190 of data, 84-86, 90 on-line, 90, 105 see also Accreditation; Errors and error analysis; Regulations; Standards Query languages, 106, 117 R Read Clinical Classification, 13, 108 Real time, 111, 157 Recommendations, IOM, general, 50-51, 176-196 Redundancy, fault tolerance, 118, 119 Registered Record Administrators (RRAs), 195 Regulations, 50, 79, 90, 147-149, 177, 192-193, 204-205 clinical reporting requirements, 3

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--> Medicare, 206-208, 214, 217 see also Licensure laws; Standards Reliability, 59, 81, 95, 109-110, 179, 218 design for, 139 see also Accuracy issues Research, 47, 48, 49, 50, 54, 68, 75, 77, 79, 110, 169, 182, 185-186, 190, 222 academic, 112, 114, 150, 159 demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 epidemiology, 66, 88, 84, 93, 127, 155, 174 federal role, 67, 155, 164-165, 174, 175 health services, support of, 45, 46, 94 problem-oriented medical record, 91 uniform record systems, 86 see also Design and development Risk factors, 66, 84, 93 S Secondary databases, 49, 50, 69, 74, 77-78, 95, 98, 110-111, 124, 161, 163, 177, 179, 181, 182, 183, 191-193 costs, 50, 110, 177, 193 defined, 55-56 Security, data, 86-87, 109-110, 126, 127-129, 147-148, 179, 214-217 design for, 14-15, 139 networks, 4, 88, 96, 148, 216 standards, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 see also Confidentiality Shared care environments, 32-34, 38 Smart cards, 32, 34, 39, 122-123 Social factors, 147-149, 156, 174 politics, 46, 48-49, 153, 195 public opinion, 153, 195 Social Security Act, 173, 174 Speech-recognition, see Voice recognition Stakeholders, 151-161, 166, 179, 183 Standard Guide for Nosologic Standards and Guides for Construction of New Biomedical Nomenclature, 108 Standards, 49, 50, 51, 110, 131-132, 160, 161, 163, 177, 180-181, 186-192, 221-222 accreditation, 65, 75, 77, 110, 149, 160, 208, 214, 217, 218 clinical practice guidelines, 51, 67, 98, 164, 181, 190 confidentiality, 131, 188 content, general, 63, 84-86, 140, 186, 187 cost factors, 146 database queries, 106, 117 data exchange and vocabulary, 12-14, 31, 34, 38, 48, 50, 51, 85-86, 96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 federal role, 66, 67, 129-131, 155, 161 format, general, 38-39, 63, 84-86, 87, 191 international, 27, 38-39, 123, 187-188 outpatient records, 63 security, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 state-level, general, 204 see also Licensure laws State governments, 50, 157, 159, 161, 169, 174-175, 177, 192, 200-223 confidentiality laws, 147-148, 208-209 demonstration projects, 157, 168 licensure laws, 147, 192, 200, 201-206, 217, 221-222 model legislation, 50, 192-193, 210, 221-222 standards, 204 Statistical analysis, 93, 95, 118 Summary time-oriented record, 62 Surgery, 121 Systematized Nomenclature of Medicine, 108 T Task-oriented medical records, 115, 117 Technicon, 120 Technological innovations, 46, 48, 68, 74, 81, 94, 100-132, 135-137, 138 advances, 3-6 barriers, general, 10-17, 126-131 computer processing power, 3 confidentiality and, 110, 126, 127-129 costs, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 see also Design and development; Diffusion, innovations; Research Telecommunications, 109 electronic mail, 47, 119, 150, 189 European, 22 reliability, 95 workstation linkages, 88 see also Networks Text processing, 106-107, 108, 126, 127, 131, 179

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--> THERESA, 112, 117-118, 127 Third-party payers, see Insurance and insurers, health; Medicaid; Medicare Time factors, 64 chart writing, 63 clerical functions, 123, 141 clinician/MEDLINE linkage, 124 data timeliness, 87 design and development of systems, 141 system response, 83, 106, 120, 126, 145-146, 220 see also Longitudinal approaches Time-oriented medical record, 115, 117 TMR (The Medical Record), 114-115 Transfer of technology, see Diffusion, innovations Treaty for the Protection of Human Rights and Fundamental Freedom, 37-38 U Unified Medical Language System (UMLS), 9, 13, 106-107, 108-109, 155, 188 Uniform Clinical Data Set, 131, 156-157 Uniform Commercial Code, 200, 219, 221 Uniform Health-Care Information Act, 192, 210, 222 Unique health identifier, 13 United Kingdom, 23-24, 26, 29, 36, 108, 122-123 Universities, 159-160 academic research, 112, 114, 150, 159 University of California at Los Angeles, 4 UNIX, 28, 137 U.S. CPR systems, status advances, 3-4, 9-10 barriers/challenges, 10-17 implementation, 8-9 market, 6-8 practice environment, 1-5 Users, 46-47, 58, 65, 70, 74-93, 143-145, 181 authentication/identification, 14, 39 computer interface with, general, 4-5, 7, 11-12, 29, 87, 88, 126-127, 179 diffusion of innovations, 142, 143-145 needs, general, 46-47, 76-93 multiple, 65 patients as, 65, 83 projections, 94-98 see also Access issues; Change agents; Stakeholders V Vendors, 100, 160-161, 162, 169, 185 legal issues, 149, 200-201, 202, 219-221 survey of, 135-137 Veterans Administration, see Department of Veterans Affairs Viruses, computer, 217, 222 Vocabulary control, 9, 11, 13-14, 25, 31, 39, 48, 50, 51, 85-86, 96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 Voice recognition, 29, 32, 106, 126-127, 131, 179, 186 W Windowing, 117, 137 Windows NT/95 environment, 28 Word processing, see Text processing Workstations, 26-28, 88, 104-105, 179 World Wide Web, 4-5