EXISTING UNIVERSAL DATABASE MODELS FULL

Many experts argue that until CPR systems are linked in some fashion to such data repositories or networks, neither will be complete or reach their full health care, research, or policymaking potential. The committee distinguishes between databases composed of secondary records and CPRs or CPR systems (IOM, 1991a Ball and Collen, 1992), but its broader vision of computer-based health information systems includes direct ties to CPR systems.

Secondary databases facilitate reuse of data that have been gathered for another purpose (e.g., patient care, billing, or research) but that, in new applications, may generate new knowledge. Furthermore, they are not intended to be the major source of information about specific patients for the treating physician. They are not under the control of a practitioner or anyone designated by the practitioner, nor are they under the management of any health institution (e.g., the medical records department of a hospital). 2 Secondary files are generated from primary records or are separate from any patient encounter (as in the case of eligibility or enrollment files for health plans and public programs). As commonly used and meant in this report, a database (or, sometimes, data bank, data set, or data file) is ''a large collection of data in a computer, organized so that it can be expanded, updated, and retrieved rapidly for various uses' (Webster's New World Dictionary, 2nd ed.).Īlthough databases may eventually be linked (or linkable) to primary medical records held by health care practitioners, this report addresses databases composed of secondary records. The term database embraces many different concepts: from paper records maintained by a single practitioner to the vast computerized collections of insurance claims for Medicare beneficiaries from files of computerized patient encounter forms maintained by health plans to discharge abstract databases of all hospitals in a given state from cancer and trauma registries maintained by health institutions and researchers to major national health survey data of federal agencies. As introduced in Chapter 1, however, health database organizations (HDOs) hold considerable promise as a reasonably comprehensive source of the information needed to:

In practice, no one system will suit every need or produce information appropriate for every question. In principle, this information can be acquired through numerous avenues, such as surveys, electronic financial transactions for health insurance claims, computer-based patient records (CPRs), and disease registries. When this is so, they can say little, with confidence, about the value of the investment in health care for population subgroups, regions, or the nation as a whole. They may not be able to determine with confidence the outcomes, quality, effectiveness, appropriateness, and costs of care for different segments of the population, for different settings, services, and providers, and for different mechanisms of health care delivery and reimbursement. Policymakers, researchers, health professionals, purchasers, patients, and others continue to be frustrated in their attempts to acquire health information. The needs are quite broad: health care reform evaluation of clinical care and health care delivery administration of health plans, groups, and facilities and public health planning. 1 Beyond debate, however, is the need for much more and much better information on use of health care services and on the outcomes of that care. No one engaged in any part of health care delivery or planning today can fail to sense the immense changes on the horizon, even if the silhouettes of those changes, let alone the details, are in dispute.

Existing universal database models