Computerized patient record for a department of respiratory rehabilitation

A computerized patient record (CPR) system plays an essential support role in the efficient functioning of the clinical and research services of a medical centre. We report the experience gained in developing a CPR for the Respiratory Rehabilitation Department (RRD) of the Tradate Medical Center of the Salvatore Maugeri Foundation, with specific reference to Out-patient (OP) and In-patient (IP) Units. The CPR was developed locally under the guidance of the Bioengineering Department. Several items implemented and strategies adopted are described and grouped in relation to broader objectives, such as the improvement of health-care quality, the enhancement of personnel productivity and reduction in costs, the support of clinical and health service research and the accommodation of future developments. In particular, we describe the design and implementation of anamnestic, physical and admission data collection, specifically orientated to respiratory diseases. Daily use of the CPR in the OP and IP units and its potential outcome for research and management support are also studied in detail. On the basis of our experience (1,251 out-patient examinations, 650 in-patient clinical admission cards), the computerized patient record seems a useful way of providing better health-care and a more comprehensive coverage of the rehabilitation process of patients in a Respiratory Rehabilitation Department.