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Will the real CPR/EMR/EHR please stand up

May 1, 1998
by root
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As healthcare turns its attention to automating patient information, the debate over the CPR heats up

While vendors and consultants spend precious time dreaming up new terms to differentiate their products, everyone else is just plain confused. One respondent to this year’s HIMSS Leadership Survey summed it up simply: "I have been walking around the HIMSS exhibit floor and I don’t know what the commercial definition of a CPR is, and I still don’t know if we even have a definition of a CPR."

We do have a definition--many definitions--and that’s part of the problem. For example, there’s the computer-based patient record (CPR), so named and defined by the Institute of Medicine (IOM), and the electronic medical record (EMR). These are the two most frequently used names, but there’s also the computerized patient record (also CPR), the electronic patient record (EPR), the virtual patient record (VPR), the electronic health record (EHR) and more.

There are two distinct camps: those who have a precise definition for a CPR, its characteristics and functionality and those who really don’t care what you call it--so long as it improves patient care and cuts costs.The first group has an ideal; the second, a practical model.

The term computer-based patient record (CPR) originated with the IOM in its 1991 report, "Computer-based Patient Records: An Essential Technology for Health Care." At that time, it defined a vision for the management of healthcare information. It remains that--a vision. From the Computer-based Patient Record Institute’s (CPRI) inception, reports Institute Chair Erica Drazen, vice president of emerging practices at First Consulting Group in Waltham, Mass., there were always those who wanted to define the CPR to the nth degree.

Some members of that early study group did a pretty good job. Their IOM gold standard for CPR is detailed and precise. But a structured, digitized and fully accessible record that meets all of the IOM’s criteria for the CPR is an ideal destined to be a long time in the making--if it’s made at all.

Meanwhile, most practical people don’t see a big difference between the CPR and the EMR and the many other terms that exist. "The important concept," says Drazen, "is that we don’t just want to automate current records; we want to create new systems that support improved patient care and reduce time and other costs spent in managing information. We call it a CPR because the Institute of Medicine identified it as a CPR in their study. Why argue with the IOM?"

Perfectly logical inside the CPRI, but the proliferation of names has persisted and a complete but inconsistent hierarchy of attributes assigned to various terms has emerged. Some, such as William Andrew, president of William F. Andrew & Associates of Winter Haven, Fla., define the differences between the CPR and the EMR by a criteria set that includes such attributes as support for dictation or diagnostic imaging. Others, such as Woody Taylor, partner in KPMG Peat Marwick’s Healthcare Practice in White Plains, N.Y., consider a CPR to be a fairly broad definition--different from an EMR, which is more closely associated with the ambulatory care environment and can be identified as a product.

And then there are those such as Peter Waegemann, executive director of the Medical Records Institute, Newton, Mass., who consider the CPR and the EMR synonymous terms. Not only is there no difference between them, he says, but even the term patient record may not be right. "Unfortunately, there is no one official name and no standards organization has the power to make a call," he asserts.

Who cares?
The terms are arbitrary to community physician Thomas Naegele, DO, of Albuquerque, N.M. "All of the definitions and the people who support them are non-physicians who don’t use computerized medical records. Who cares? I don’t care what you want to call them. That’s not my mission or my fight. I call them computer notes, but whatever you want to call them is fine by me."

Drazen agrees. "It doesn’t make a difference. We could call it a banana, and it wouldn’t make a difference. I attribute the many terms used to describe the CPR to the fractionalization of the thought leadership. In the early days of the CPRI, a number of participants were passionate about the definition and the terminology choice. When any group comes together, there are always some who disagree. What do they do? They split off, go on their own and start a new temple. And that has happened. It is very unfortunate because it confuses the market."

In the absence of industry consensus and with full knowledge of its political baggage, Healthcare Informatics has adopted the IOM’s term, computer-based patient records.

The IOM report provided a detailed definition of CPR attributes and functionality. Its precision and attention to detail is characteristic of academic endeavors. It was a vision--and it still is. In the end, the problems with definition, as with identification, may boil down to the difference between an academic definition and a practical one. That’s OK so long as the industry can easily differentiate between the two, but the line separating them isn’t clear. At this point, the CPR definition occupies a wide, gray swath running between two extremes.