Computerization of the medical record: Use in care of patients with endstage renal disease

Abstract

An on-line computerized medical record system that has been in use for over 5 years is described. Manual forms are a time-oriented problem and event list, a time-oriented record for renal failure, and records for hemodialysis and peritoneal dialysis. The data are entered directly from the forms into the computer. Individual data can be rearranged for display in predetermined or in previously unanticipated ways. Automatic short- and long-term summaries of data on individual patients are available virtually instantaneously. The system has greatly facilitated patient care and the quality control of patient care.