This book has been a long time in the making. The computerization activi­ ties described in these pages began in 1977 at the Department of Veterans Affairs (VA), but we devoted most of our focus and efforts to building and then implementing the extensive hospital information system known as the Decentralized Hospital Computer System (DHCP) throughout VA. Deliv­ ering the product has been our primary goal. We spent relatively little time documenting or describing our experiences or lessons learned. Except for some presentations at national meetings and a relatively few publications, almost none of which were in the standard trade journals read by Chief Information Officers (CIOs) and equivalent top managers in the private and nonprofit sectors, VA's accomplishments remained a well-kept secret. In 1988, Helly Orthner encouraged VA staff to consider writing a book, but the press of day-to-day activities always seemed to take precedence, and the book languished on the back burner.

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Section 1-Networking for Healthcare Delivery.- 1-Vision for Change: An Integrated Service Network.- 2-The Role of Systems at the Facility and Network Level.- 3-Teleinformatics: The Future of Healthcare Quality Management.- Section 2-System Design.- 4-Creating a Robust Multi-Facility Healthcare Information System.- 5-Infrastructure and Tools for Flexibility.- 6-Structuring Databases for Data Sharing.- 7-Collaborating for Integration.- 8-Supporting Systems After Installation.- 9-Privacy and Security Protections for Healthcare Information.- Section 3-Clinical Information Technology.- 10-Integrating a Clinical System.- 11-Capturing Data in Ambulatory-Care Settings.- 12-Moving to Clinical Workstations.- 13-Controlled Representation in Patient Records and Healthcare Delivery Systems.- 14-Clinical Decision Support in a Distributed Environment.- 15-The CARE Decision Support System.- Section 4-Clinical and Support Applications.- 16-Meeting Clinical Needs in Ambulatory Care.- 17-Surgical Systems.- 18-Nursing Use of Systems.- 19-Developing Clinical Computer Systems: Applications in Cardiology.- 20-Anesthesiology Systems.- 21-The Library Network: Contributions to the VA's Integrated Information System.- 22-Using Data for Quality Assessment and Improvement.- 23-Developing and Implementing the Problem List.- Section 5-System Evolution.- 24-Conceptual Integrity and Information Systems: VA and DHCP.- 25-Hybrid Open Systems Technology.- 26-Using DHCP Technology in Another Public Environment.- 27-International Installations.- Section 6-Telemedicine and Telehealth.- 28-Telemedicine: Taking a Leadership Role.- 29-Telemedicine at the Veterans Health Administration.- 30-Telehealth for the Consumer.- 31-Digital Imaging Within and Among Medical Facilities.- Contributors.