The background, requirements, and design of a computer-based medical record for nurse practitioners in ambulatory care are described. The major objective was to test the acceptability to primary health care providers of direct entry of narrative information. After a l-year clinical trial, the system was evaluated. Although most of the objectives were achieved, changing requirements and lack of acceptability resulted in withdrawal of the system from the clinical setting. A discussion of the reasons for this unacceptability and theconditions which would have to be met in order to reimplement the system is included.
Computer-based, problem-oriented medical records offer many real and potential advantages in the delivery of health care. Many have cited the collection of better data, the greater accessibility of information, the better educational potential, the increased administrative flexibility, and the facilitation of audit when computers are used to collect, store, manipulate, and present medical record information (I-3). In an attempt to alleviate some of the problems associated with recordkeeping in a large urban outpatient clinic, an interactive system for entering and retrieving documentation of Nurse Clinic visits was developed. After a l-year clinical trial, the system was evaluated. This paper describes the clinical setting, the project objectives, the essential features of the system, its implementation and utilization, and the results of the evaluation.