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In 1991, the University of Wisconsin Hospital and Clinics (UWHC) began implementing a computer-based patient record (CPR). The CPR includes a patient's demographic information, active problems, family history, test results, clinical observations, vital signs, active medications, and allergies, along with images and documents. Exhibit 1 illustrates the components of the CPR, and Exhibit 2 illustrates how the CPR stores and provides access to data. (Exhibits 1 and 2 omitted)
UWHC's implementation plan approached the CPR as a revolutionary tool that would be implemented in an evolutionary way. When planning began, UWHC already had automated the collection of patient data from diverse sources in its healthcare network (for example, from registration, nursing, pharmacy, laboratory, and radiology departments). The next step toward a fully functioning CPR was to store significant patient data collected from these and other sources. UWHC achieved this goal by developing a repository of clinical information in partnership with its information systems vendor.
This repository stores summarized, longitudinal clinical data collected during patient visits. The repository must accommodate a large volume of detailed patient information; for example, it must store information on more than 400,000 outpatient visits in a year.
In this repository, data are organized so that patient-centered information can be viewed by various users in a way that fulfills their particular needs. For example, physicians access clinical information from hundreds of workstations throughout the hospital and clinics and from their home personal computers via modems. They have ready access to patient histories, laboratory results, and discharge summaries.
UWHC's CPR has helped reduce the nurse intake time necessary for initial physician office visits from 35 minutes to 20 minutes. Return visits that used to take 35 minutes now take 15 minutes.
Nurses, rather than having to collect redundant information, call up information in a format that they can update. As a result, nurses have reported that their productivity has improved. For example, patient assessments are completed more quickly with the use of assessment screens that display a patient's history, vital signs, weight, and medical problems.
By 1993, physicians and nurses were declaring the CPR a success. It gave them the information they needed to improve quality of care and productivity, and it was useful for research and teaching. The CPR also protected confidentiality...