Technical challenges past and future in implementing THERESA: a one million patient one billion item computer-based patient record and decision su

摘要

Abstract: Challenges in implementing a computer-based patient record (CPR) - such as absolute data integrity, high availability, permanent on-line storage of very large complex records, rapid search times, ease of use, commercial viability, and portability to other hospitals and doctor's offices - are given along with their significance, the solutions, and their successes. The THERESA CPR has been used sine 1983 in direct patient care by a public hospital that is the primary care provider to 350,000 people. It has 1000 beds with 45,000 admissions and 750,000 outpatient visits annually. The system supports direct provider entry, including by physicians, of complete medical `documents'. Its demonstration site currently contains 1.1 billion data items on 1 million patients. It is also a clinical decision-aiding tool used for quality assurance and cost containment, for teaching as faculty and students can easily find and `thumb through' all cases similar to a particular study, and for research with over a billion medical items that can be searched and analyzed on-line within context and with continuity. The same software can also run in a desktop microcomputer managing a private practice physician's office.!1