In summary, PCHIS is a hybrid electronic-paper medical record system that is clinically useful to health care providers. The paper chart still contains the bulk of information but the key facts about any given patient (diagnoses, surgeries, medications, allergies) and about the process of care (frequency of visits, referral patterns, test ordering, etc.) are readily available in electronic form. These key data are easily coded, are quickly and simultaneously accessible in multiple locations, serve as an excellent chart substitute whenever the paper chart is unavailable, and can be retrieved for in-depth analysis at any time, whether for clinical, administrative, research, or quality assurance purposes. The process of care can be studied and, to some extent, can also be modified by the system, as demonstrated by the physician response to the reminder system within PCHIS. The medical record chart summary, mandated by Joint Commission for ambulatory patient charts, is easily provided in hard copy as well as electronically. Whereas physician compliance in providing data to the system was initially sporadic, physician support has increased tremendously as the system has become more clinically useful to them. It is a system that exists and functions well within a patchwork of multiple different medical information systems. It is a system with sufficient intrinsic flexibility that it can and will continue to evolve in response to the needs of physicians and administrators.