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A Strategy for Redesigning the Medical Record for Quality Assurance

Bibliographic Data

ID9103033
AuthorsDavid D Wirtschafter (University of Alabama, corresponding author), Emmanuel Mesel
Year1976
Volume14
Issue1
Pages68-76
Publication date1976-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-197601000-00007
PMID950812
OpenAlexW2013936434
LanguageEN
References cited6

The medical record should be viewed as an instrument to facilitate and demonstrate the achievement of explicit health care goals. Current systems do not accomplish this. Our examination of the traditional record suggests that modifications of the record should be based on the principles of information system design theory. Necessary modifications include changes which prompt the monitoring of the outcome parameters of a patient's illness, encourage the analysis of the patient's outcome, and facilitate adaptive (corrective) actions. We have termed those data elements which describe the achievement of patient-specific, problem-specific objectives as the "minimum care assurance data set." To designers of computerized medical information systems, this approach provides a rationale for selecting which data to place in computer storage from the myriad of detail in the traditional paper record

Health care · Medical record · Operations management · Outcome (game theory) · Process management · Quality (philosophy) · Quality assurance · Risk analysis (engineering) · Set (abstract data type) · Business Process Modeling and Analysis · Computer Science · Data Quality and Management · Electronic Health Records Systems · Engineering · Medicine

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Citation velocityhistorical
Highly citedNo

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