Optometric records which have evolved in private practice must be reco
nsidered when included in a comprehensive care environment. These hosp
ital, health maintenance organization (HMO), preferred provider organi
zation, and similarly linked systems require a higher degree of commun
ication among specialties than do self-standing practices. Furthermore
, the administrative requirements of such a system require more standa
rdization, cost sensitivity, medicolegal compliance, and other element
s peculiar to a comprehensive facility. The expanded scope of care pro
vided by optometrists within a hospital requires familiarity with a ne
w range of procedures, languages, and reports. Information from labora
tories, radiology, and other areas must be incorporated into the optom
etric record. Continuity of care is more complex. Opportunities for st
rong interprofessional synergies within the organization arise directl
y from preactivity in optometric record keeping. New legal hot spots a
rise from questions of records ownership, access, and privacy. Billing
procedures are becoming extremely important, with significant effects
on quality assurance audits, coding, doctor ''profiling'' against fra
ud, and abuse; these priorities can interfere with clinical priorities
. Driven primarily by the concerns and resources of large third-party
payers, technology is making rapid changes in the form of optometric r
ecord keeping in comprehensive systems. Electronic data management wil
l change the face of medical records, although administrative data wil
l be digitized much more quickly than clinical notes. Comprehensive ca
re environments will be the ''test beds'' for these technologies. Opto
metry is in a flood position to show its contribution to the health ca
re team through leadership in the implementation of new record keeping
models.