Almost all British general practitioners use computer based patient records, but most hospital doctors do not. This review (the first of two) focuses on how, over 30 years, incentives led to enthusiastic adoption of computing by general practitioners but widespread alienation of hospital doctors.
#### Summary points
Almost all British general practitioners use computers in their consulting rooms, but most hospital doctors do not
Over 30 years, leaders of the general practitioner profession have worked with government to provide incentives for computerising practices and to remove barriers
In hospitals computing was treated as a management overhead, and doctors had no incentives to become involved
The success of the government's plans for “joined up,” computer based health services depends on providing appropriate incentives to hospital doctors
This article has had a long gestation. Much of the evidence comes from my experience over nearly 30 years, first as leader of the computer evaluation unit at the Charing Cross Hospital, London (1974-80), then as a general practice system supplier (1980-90), and as a supplier of clinical information systems for hospital doctors (1990-9). An initial version of the article was written in 1993 and extended for the NHS Executive's integrated clinical workstation project 1995. A later version was presented at the AMIA Symposium, Washington DC, November 2001 (proceedings, pp 42-6).
Wanless pointed out Britain's particularly poor record on the use of information technologies in the health service and called for an immediate doubling of expenditure on computing.1 The Department of Health has responded with a new national strategy to deliver the benefits of working practices supported by information technology and computer based records across the NHS.2 Concern is not limited to Britain: in 2001 the US Institute of Medicine stated that “IT must play a central role … if a substantial improvement in quality is …
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