Computer-based patient records, although an area of active research, are not in widespread use. In June 1992, 38% of Dutch general practitioners had introduced computer-based patient records. Of these, 70% had replaced the paper patient record with a computer-based record to retrieve and record clinical data during consultations. Possible reasons for the use of computer-based patient records include the nature of Dutch general practice and the early and active role of professional organizations in recognizing the potential of computer-stored patient records. Professional organizations issued guidelines for information systems in general practice, evaluated available systems, and provided postgraduate training that prepares physicians to use the systems. In addition, professional organizations successfully urged the government to reimburse general practitioners part of the expenses related to the introduction of computer-based patient records. Our experience indicates that physicians are willing and able to integrate information technology in their practices and that professional organizations can play an active role in the introduction of information technology.

New technologies are now emerging that have Objective-To study the effects of the introduction considerable potential for improving communication.of electronic data interchange between primary and One such technology is electronic data interchange, secondary care providers on speed of communi-defined as "standard electronic messages conveyed cation, efficiency of data handling, and satisfaction from one computer to another without mdnual interof general practitioners with communication.vention. "' In the Netherlands several organisations Design-Comparison of traditional paper based have cooperated to standardise messages in health care communication for laboratory reports and admis-using the Edifact standard,"'''" which describes the sion-discharge reports between hospital and general syntax of messages. Several standardised messages practitioners and electronic data interchange.are available, including a laboratory report and an Setting-Twenty-seven general practitioners admission-discharge report. Using such a standardised whose offices were equipped with a practice infor-message a laboratory can, for instance, transmit test mation system and two general hospitals.results electronically to a general practitioner's comOutcome measures-Paper based communication puter system, which can then manipulate and store was evaluated by questionnaire responses from and the data automatically. interviews with care providers; electronic communiIn the Netherlands the infrastructure required for cation was evaluated by measuring time intervals electronic data interchange is emerging. Many hospitals between generation and delivery of messages and by have already had years of experience with information assessing doctors' satisfaction with electronic data systems, and in primarv care computer based patient interchange by questionnaire.records are gaining ground rapidly. At present half of Results-Via paper mail admission-discharge all Dutch general practitioners (over 3000) are using an reports took a median of 2-4 days, and laboratory information system in daily practice, and 1300 of them reports 2 days, to reach general practitioners. With are using computer based patient records. electronic data interchange almost all admissionIn this paper we describe a project that studied discharge reports were available to general prac-electronic communication between hospitals and titioners within one hour of generation. When general practioners. The aims of the study were (a) to samples were analysed on the day of collection (as introduce electronic data interchange in a health care was the case for 174/542 samples in one hospital and environment, (b) to assess the gain in speed of delivery 443/854 in the other) the laboratory reports were of reports achieved using electronic data interchange Department ofMedical also available to the general practitioner the same instead of paper mail, (c) to measure the influence of

The Internet has become an inevitable tool for collecting health and health behavior questionnaires. This study compared the feasibility, presence of score differences, and subjective evaluations by children between Internet and identical paper (asthma/fruit) questionnaires in elementary schools. A randomized crossover design was applied, with children starting with one administration mode before completing (5 minutes later) the other mode. Ten Dutch elementary schools with 270 school children (fifth grade, 10-12 years) were approached to participate. Response was 92%. The Internet mode had significantly less missing/nonunique answers than the paper mode (p < .01). The completion times did not differ significantly between the Internet and the paper mode. Except for perceived self-efficacy to eat sufficient fruit (p < .05), no differences in the asthma and fruit scores were found when comparing between the 2 modes. All variables showed strong intraclass correlation coefficients (166 >or= 0.64) between modes. Most items had good to very good agreement (kappa 0.61-0.95). The percentages for global and exact agreement ranged per item from 61.3 to 100. Most children preferred the Internet mode on "general preference" and "ease of use" aspects but rated no preference on "understandability." The majority rated the evaluation aspects of the Internet mode positively. Thus, Internet administration of a health and health behavior questionnaire is feasible at elementary schools, gives comparable responses, and is well accepted and preferred by children compared to the paper version. Therefore, it is recommended to use Internet as a tool in health and health behavior research among children.

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Study objective -Dutch public health services are charged with collective preventive care for the population -care that should, by law, be based on epidemiological data. General practices potentially offer important data for this purpose, particularly since more and more use a computer. This study aimed to assess whether it is possible to obtain useful epidemiological data from this source.