Use and Impact of Computers in Clinical Medicine

366 Pages·1987·6.846 MB·English

by  James G. Anderson, Stephen J. Jay (auth.), James G. Anderson, Stephen J. Jay (eds.)

Computers and Medicine
Bruce I. Blum, Editor
Computers and Medicine
Information Systems for Patient Care
Bruce 1. Blum (Editor)
Computer-Assisted Medical Decision Making, Volume 1
James A. Reggia and Stanley Tuhrim (Editors)
Computer-Assisted Medical Decision Making, Volume 2
James A. Reggia and Stanley Tuhrim (Editors)
Expert Critiquing Systems
Perry L. Miller (Author)
Use and Impact of Computers in Clinical Medicine
James G. Anderson and Stephen J. Jay (Editors)
Use and Impact of Computers
in Clinical Medicine
Edited by
James G. Anderson and Stephen J. Jay
With 21 Illustrations
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
James G. Anderson Stephen J. Jay
Professor of Sociology Senior Vice President for Academic Affairs
Purdue University and and Information Services
Methodist Hospital of Indiana Methodist Hospital of Indiana
Indianapolis, Indiana 46202, U.S.A. Professor of Medicine and Assistant Dean
Indiana University School of Medicine
Indianapolis, Indiana 46202, U.S.A.
Series Editor
Bruce I. Blum
Applied Physics Laboratory
The Johns Hopkins University
Laurel, Maryland 20707, U.S.A.
Library of Congress Cataloging in Publication Data
Use and impact of computers in clinical medicine.
(Computers and medicine)
Includes bibliographies and index.
1. Medicine-Data processing. 2. Information
storage and retrieval systems-Hospitals. I. Anderson; James G., 1936- . II. Jay,
Stephen J.
III. Series: Computers and medicine (New York, N. Y.)
[DNLM: 1. Computers. 2. Medicine. W 26.5 U836]
R858.U84 1986 610'.28'5 86-13072
© 1987 by Springer-Verlag New York Inc. All rights reserved. No part of this book may be
translated or reproduced in any form without written permission from Springer-Verlag, 175
Fifth Avenue, New York, New York 10010, U.S.A.
Softcover reprint of the hardcover 1st edition 1987
The use of general descriptive names, trade names, trademarks, etc. in this publication,
even if the former are not especially identified, is not to be taken as a sign that such names,
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While the advice and information in this book are believed to be true and accurate at the
date of going to press, neither the authors nor the editors nor the publisher can accept any
legal responsibility for any errors or omissions that may be made. The publisher makes no
warranty, express or implied, with respect to the material contained herein.
Typeset by Huron Valley Graphics, Inc., Ann Arbor, Michigan.
9 8 7 6 5 432 1
ISBN-13:978-1-4613-8676-6 e-ISBN-13:978-1-4613-8674-2
DOl: 10.1007/978-1-4613-8674-2
Series Preface
Computer technology has impacted the practice of medicine in dramatic
ways. Imaging techniques provide noninvasive tools which alter the diag
nostic process. Sophisticated monitoring equipment presents new levels of
detail for both patient management and research. In most of these high
technology applications, the computer is embedded in the device; its
presence is transparent to the user.
There is also a growing number of applications in which the health care
provider directly interacts with a computer. In many cases, these applica
tions are limited to administrative functions, e.g., office practice manage
ment, location of hospital patients, appointments, and scheduling. Nev
ertheless, there also are instances of patient care functions such as results
reporting, decision support, surveillance, and reminders.
This series, Computers and Medicine, focuses upon the direct use of
information systems as it relates to the medical community. After twenty
five years of experimentation and experience, there are many tested ap
plications which can be implemented economically using the current gen
eration of computers. Moreover, the falling cost of computers suggests
that there will be even more extensive use in the near future. Yet there is
a gap between current practice and the state-of-the-art.
This lag in the diffusion of technology results from a combination of
two factors. First, there are few sources designed to assist practitioners in
learning what the new technology can do. Secondly, because the potential
is not widely understood, there is a limited marketplace for some of the
more advanced applications; this, in turn, limits commerical interest in
the development of new products.
In the next decade, one can expect the field of medical information
science to establish a better understanding of the role of computers in
medicine. Furthermore, those entering the health care professions al
ready will have had some formal training in computer science. For the
near term, however, there is a clear need for books designed to illustrate
VI Series Preface
how computers can assist in the practice of medicine. For without these
collections, it will be very difficult for the practitioner to learn about a
technology which certainly will alter his or her approach to medicine.
And that is the purpose of this series: the presentation of readings
about the interaction of computers and medicine. The primary objectives
are to describe the current state-of-the-art and to orient medical and
health professionals and students with little or no experience with com
puter applications. We hope that this series will help in the rational
transfer of computer technology to medical care.
Laurel, Maryland BRUCE I. BLUM
Preface
Bruce Blum pointed out in the Preface to the Computers and Medicine
Series that although there are many medical computer applications that
could be implemented economically, there is a gap between current prac
tice and the state-of-the-art. On the one hand, information systems have
been developed that can assist health care institutions with cost reduction,
operations, and patient care. On the other hand, surveys have consis
tently indicated that despite the development of an enormous number of
computer-based medical information systems, their dissemination and
utilization are limited.
What accounts for this limited implementation and underutilization of
clinical computing systems? At present, the process by which computer
applications are adopted and diffuse and become part of the clinical prac
tice of physicians is poorly understood. Effective public policies in the
form of incentives, subsidies, and regulations, however, cannot be devel
oped without a better understanding of the process through which com
puter systems are implemented in various practice settings. Moreover, a
clear understanding of this process and the factors that influence it is
essential for those professionals who are developing the next generation
of medical computing systems.
Computers have the potential to extend dramatically the physician's
ability to provide health care. At the same time, computers may signifi
cantly alter the physician's professiona
role, the nature of the doctor-patient relationship, and the organization
of the health care delivery system. The challenge for the future is to
develop organizational arrangements and incentives designed to enhance
humane values while capitalizing on the advances in medical computing.
The objective of this book is to bring together papers that provide
major research findings concerning the factors that affect the adoption,
diffusion, utilization, and impact of computers in clinical medicine. Areas
of needed research will be highlighted. The book is aimed at the growing
viii Preface
number of practitioners, researchers, and students in medicine, the bio
medical sciences, engineering, and computer science who use or assist in
the development of medical computing systems.
The chapters that follow deal with clinical information systems. Blum
has defined these systems as applications that manage clinical data by
creating a database that can be used by clinicians in providing health care.
In this book, we have focused on large systems, most of which are hospital
based. We have excluded financial systems that do not include clinical
data, embedded computer applications that are largely transparent to the
users, laboratory systems, and physiological monitoring systems. Also, we
have chosen not to deal at this time
with the growing number of microcomputer-based systems. Factors that
affect the adoption, diffusion, utilization, and impact of microcomputer
based systems may not be the same as for mainframe systems. However,
there are few reported studies of microcomputer-based clinical systems to
draw upon at this time.
Most of the computer applications reported in this book have been
introduced into hospitals. This practice setting is important for several
reasons. Until recently, information systems have been implemented in
hospitals largely because of their cost. Second, the hospital has become
an institutional workplace for significant portions of the time for the
majority of physicians. Not only are hospital services administrative units,
but also they are organized around specialties. Consequently, physicians
on a particular hospital service share common medical education experi
ences, types of patients, practice patterns, professional norms, and expec
tations. There is more formal and informal interaction among physicians
on these services. Hospitals, then, are important practice settings in
which to study the diffusion and use of clinical information systems by
physicians and their effects on medical practice.
We wish to thank the many contributors to this volume. Grant HS
04774 from the National Center for Health Services Research and Health
Care Technology Assessment helped to support the research that resulted
in a number of the contributions to this book. We also wish to thank the
house staff and medical staff of Methodist Hospital of Indiana for their
generous participation in our research effort and Marilyn Anderson who
assisted us with the data analysis and the preparation of this book. Fi
nally, we with to thank Bruce Blum for his encouragement and the edi
tors and staff at Springer-Verlag for their assistance in producing this
volume in the Computers and Medicine Series.
JAMES G. ANDERSON
STEPHEN J. JAY
Contents
Series Preface V
Preface Vll
Contributors xiii
I. Introduction
1. The Diffusion of Computer Applications in Medical Settings 3
James G. Anderson and Stephen J. Jay
2. What Makes Doctors Use Computers?: Discussion Paper 8
D.W. Young
3. Medical Technology: Assessment, Adoption, and Utilization 15
Ann Lennarson Greer
II. Adoption: The Physician's View of Computers in Medicine
4. The Influence of Medical Values and Practices on Medical
Computer Applications 39
Bonnie Kaplan
5. What do Professional Persons Think About Computers? 51
Elizabeth Zoltan-Ford and Alphonse Chapanis
6. An Analysis of Physician Attitudes Regarding
Computer-Based Clinical Consultation Systems 68
Randy L. Teach and Edward H. Shortliffe
7. Physician Attitudes Toward Applications of Computer
Database Systems 86
Joseph Singer, Henry S. Sacks, Frank Lucente,
and Thomas C. Chalmers
x Contents
8. Why Doctors Don't Use Computers: Some Empirical
Findings 97
James G. Anderson, Stephen J. Jay, Harlan M. Schweer, and
Marilyn M. Anderson
III. Diffusion of Medical Computer Applications
9. Diffusion of Innovations: An Overview 113
Everett M. Rogers
10. Embracing or Rejecting Innovations: Clinical Diffusion of
Health Care Technology 132
H. David Banta
11. Computers and Clinical Judgment: The Role of Physician
NetWorks 161
James G. Anderson and Stephen J. Jay
12. Physician Communication Networks and the Adoption and
Utilization of Computer Applications in Medicine 185
James G. Anderson, Stephen J. Jay, Harlan M. Schweer,
Marilyn M. Anderson, and David Kassing
IV. Utilization of Clinical Computer Systems
13. Clinical Computing in a Teaching Hospital 205
Howard L. Bleich, Robert F. Beckley, Gary L. Horowitz,
Jerome D. Jackson, Edna S. Moody, Caryn Franklin,
Sandra R. Goodman, Michael W. McKay, Richard A. Pope,
Timothy Walden, Saul M. Bloom, and Warner V. Slack
14. Implementing Computerization in Hospitals: A Case Study
of the Behavioral and Attitudinal Impacts of a Medical
Information System 224
Michael A. Counte, Kristen H. Kjerulff, Jeffrey C. Salloway, and
Bruce C. Campbell
15. Evaluation of a Computerized Drug Review System:
Impact, Attitudes, and Interactions 238
Carole Siegel, Mary Jane Alexander, Yosef D. Dlugacz, and
Susan Fischer
16. A Structural Model of the Impact of Physicians' Perceptions
of Computers on the Use of Hospital Information Systems 257
James G. Anderson, Stephen J. Jay, Harlan M. Schweer, and
Marilyn M. Anderson