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The Literature of Medicine |

The Introduction of Computer-based Patient Records in the Netherlands

Johan van der Lei, MD, PhD; Joop S. Duisterhout, MSc; Henk P. Westerhof, MD; Emiel van der Does, MD, PhD; Paul V. M. Cromme, MD, PhD; Wilfried M. Boon, MS; and Jan H. van Bemmel, PhD
[+] Article, Author, and Disclosure Information

From the Faculty of Medicine and Health Sciences, Erasmus University, Rotterdam; the Dutch College of General Practitioners and the Dutch Association of General Practitioners, Utrecht, the Netherlands. Request for Reprints: Johan van der Lei, MD, PhD, Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands. Acknowledgments: The authors thank A.R. Esch, MD, of the Dutch Association of General Practitioners, for providing data on use of information systems by general practitioners.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(10):1036-1041. doi:10.7326/0003-4819-119-10-199311150-00011
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Computer-based patient records, although an area of active research, are not in widespread use. In June 1992, 38% of Dutch general practitioners had introduced computer-based patient records. Of these, 70% had replaced the paper patient record with a computer-based record to retrieve and record clinical data during consultations.

Possible reasons for the use of computer-based patient records include the nature of Dutch general practice and the early and active role of professional organizations in recognizing the potential of computer-stored patient records. Professional organizations issued guidelines for information systems in general practice, evaluated available systems, and provided postgraduate training that prepares physicians to use the systems. In addition, professional organizations successfully urged the government to reimburse general practitioners part of the expenses related to the introduction of computer-based patient records.

Our experience indicates that physicians are willing and able to integrate information technology in their practices and that professional organizations can play an active role in the introduction of information technology.


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Figure 1.
The number of general practitioners using information systems.

The top curve shows the percentage of Dutch general practitioners who used an information system in their practice from 1978 to 1992. The lower curve shows the number of physicians who had purchased and installed computer-based patient records.

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Figure 2.
Encounter screen from Elias.P

Elias, an information system for primary care, supports a computer-based patient record. Shown here is the encounter screen used by the general practitioner to enter data during a consultation. At the top of the screen, name, address, age, and sex are shown, followed by a few lines containing pertinent events from the patient's history (for example, known allergies). Markers identify chronic diseases (DM = diabetes mellitus, HY = hypertension). In the lower part of the screen, the first column lists the date of the encounter and the physician's initials. The next column refers to SOAP coding: S = subjective, O = objective, A = assessment, = plan. The third column identifies a problem from the problem list in this example, only the entries associated with a single problem, hypertension, are shown. The fourth column identifies the specific coding resource that has been used to code data: M = coded measurements, D = diagnoses coded according to International Classification of Primary Care codes (such as K86, R05, and A13), and R = coded prescriptions.

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