Changes in the health care environment produced fundamental hafts In the delivery of health care, favoring outpatient care over Impatient care, primary care over specialty care, and guidelines-driven care over autonomous decision making. Technological advances have overcome some barriers to computer- based patient records (CPRM) (e. G.
, World Wide Web, applications that operate across distances on many different computers) and heightened the volleyballs of others (e. . , confidentiality policies and legislation). In this commentary, we describe some of the environmental and technological changes that have occurred since publication of the iris edition and highlight the challenges that remain to be addressed. Probably the most significant anthropological change that occurred since 1991 was the change in the health care practice environment.
We begin by addressing the new environment. As health care costs in the united States approached $1 trillion in the early sass, businesses, consumers, and payers began to call for mechanisms to manage the escalating costs (MOM, 1993). This issue was so much at the forefront of U. S. Business and political priorities, that the 1992 presidential election was dominated.
