No free lunch: institutional preparations for computer-based patient records.

The Veterans Administration (VA) is aggressively pursuing computer-based medical records by deploying the Computerized Patient Record System (CPRS) across its 150 medical centers and 400 outpatient clinics. CPRS's client-server, patient-centered approach to clinical computing is a departure from VA's traditional terminal-compatible, department-centered approach. Although the CPRS software is freely distributed, institutional readiness for computer-based patient records has proven expensive. Preparations include organizational changes, human resource development, hardware deployment, physical plant upgrades, and software testing. This paper details CPRS preparations and their costs at one VA Medical Center. Lessons learned during the process are summarized.