Role of the electronic patient record in the development of general practice in the Netherlands

From the end of the seventies practice computer systems have been introduce d in Dutch general practice. In 1998 90% of the GPs had a practice computer and 60% used it for medical purposes, with good patient acceptance. Collab oration between pioneer GPs, professional organizations, academic instituti ons and software manufacturers has been of decisive importance. While the p ractice computer is early recognized as a powerful tool for administrative purposes, it is increasingly supporting clinical and preventive care, quali ty of care improvement, clinical training of students and vocational traini ng of general practice trainees. Also for scientific research and practice supporting research, automatization has proven to be innovating. Much atten tion is paid to designing valid databases and database-related research. In addition, practice automatization has opened new perspectives for health p olicy and management. Further development of technical and methodological i ssues is needed, and, very importantly, of patients' and consumers' involve ment. EPR technology in general practice does not optimally work without go od numerator and denominator data, and a good quality patient-doctor relati onship over time. While the EPR is a useful tool to facilitate a better per formance, it may enable the doctor to focus more on the health care essenti als.