While development of informatics systems allowing physician access to medical records has met with considerable success, few systems have been developed for direct, structured, computerized physician entry of medical data. Most developed systems have involved dictation rather than direct physician entry, but dictation substantially decreases the level of structure which can be obtained from the resulting medical records. We report on the successful development of a comprehensive clinical informatics system which included direct physician entry of data. With the assistance of a commercial sponsor, the Preanesthetic Evaluation Clinic at the University of Florida has developed a physician-entry computerized medical records system, first implemented in 1991. Using a local area network and Microsoft Windows graphical interface, the interface was physician-friendly and designed for direct input by all clinic personnel, including clerical, nursing, and physicians.[1-3] Usage of the system exceeded expectations. Over 30,000 patient's records have been completed using the computerized system. Laser-printed, double-sided forms of structured, problem-oriented medical data are placed in the traditional chart, while an electronic copy is maintained on the local area network, for retrieval or editing at the next preanesthetic evaluation. This system was shown to have no time penalties compared to the previous manual system, [4] yet had significant financial benefit to the institution [5]. In a test of 180 outpatient charts coded by our hospital's exit coders, the system resulted in over $40,000 increased earnings for the hospital billing for later surgery. To our knowledge, it is the only successful physician-entry preanesthetic evaluation system with complete documentation of patient problems in the world. Electronic textbook professional support was simultaneously developed within our institution, as well as access to commercial versions of MEDLINE and additional CR-ROM texts. Physicians have simultaneous access to these resources while completing their evaluations. At the same time, our medical center developed a centralized repository of all transcribed physician's reports, including admission and discharge, operative, echocardiography, radiological, electrocardiographic, Holter, and nuclear medicine reports. Our team developed software to give our physicians simultaneous access to this giant repository while completing their preanesthetic evaluation. [6] Downloading of preanesthetic data from our computerized system to the medical center's repository was made automatic, with no transcription or other charges incurred. Concurrent with these developmers, our nursing department developed a comprehensive education program for outpatients, covering all aspects of their upcoming surgery. Nurses became facile with the computerized record keeping system, and assisted with data entry, satisfying requirements placed on them by hospital and accreditation groups for nursing data collection. This reduced their workload and made the patient's visit more cohesive. Finally, our clinic has implemented a scan-form system in conjunction with outlying surgical clinics to allow many ASA-PS 1 or 2 patients to avoid an unnecessary trip to the hospital for further evaluation prior to the day of surgery, while continuing to gather electronic medical record information about the patient.