Compurerized Medical Imaging and Graphics. Vol. 13. No. I. pp. 137-143. 1989 Printed in the U.S.A. All ri@ts teserved. 0895-61 I l/89 $3.00 + .CHl Copyright 0 1989 Pergamon Press plc THE IMPACT OF COMPUTER SYSTEMS IN A MEDICAL ENVIRONMENT K. H. Kjerulff Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD 2 120 1, U.S.A. J. C. Salloway Center for Health Promotion and Research, University of New Hampshire, Durham, NH 03824, U.S.A. and M. A. Counte Department of Health Systems Management, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL 606 12, U.S.A. (Received 13 November 1987) Abstract-The acceptance and proliferation of computer technology in health care has not been as rapid as many expected. Research in this area suggests that several factors are related to computer acceptance including social network processes, attitudes toward computers, and personality characteristics. Potential implications for the field of magnetic resonance imaging are discussed. Key Words: Technology acceptance, Attitudes toward computers, Impacts of computers, Computers in health care, Hospital information systems, Acceptance of magnetic resonance imaging The average hospital in the United States is currently devoting anywhere from 2 to 7% of its annual budget to computer-related expenses [ 7,241. For a small hos- pital this can represent quite a bit of money. For a large hospital this may mean $4 or $5 million a year devoted to computer costs. For most hospitals com- puterization is devoted primarily to various types of information systems-that is, systems designed to aid in the storage and retrieval of information. A nationwide survey of hospitals [ 141 found that nearly every hospital has computerized procedures concerned with financial and accounting applica- tions. The second most common type of information system concerns the admission, discharge, and transfer of patients. Information systems devoted to laboratory, pharmacy, radiology, and nursing order entry were also not uncommon, although much less frequent than the financial and accounting systems. There are even fewer hospitals with systems devoted to clinical purposes such as decision support systems for physicians or care plan systems for the nursing staff. There are several reasons for this relative lag in clinically relevant systems in the United States. First, these types of systems require the existence of a well- developed patient database; that is, some type of hos- pita1 information system (HIS) must already exist on which to build a clinically relevant system. For many hospitals the implementation of any type of inte- grated HIS is extremely expensive, difficult, and time consuming, taking anywhere from 2 to 10 years to complete. Many systems are out of date before they are completed. The second reason is that in this age of cost containment, it is easier to justify the basic HIS functions as cost effective, particularly those con- cerned with finance and accounting and staff man- agement. Computer applications designed to aid in clinical decision making or care planning are less ob- viously “cost effective” and considerably less likely to be implemented, particularly in community hospi- tals. A third reason why there is a relative lag in the implementation of computerized clinical applica- tions in health care is that physicians and nurses tend to be somewhat cautious as concerns computers [2,6, 13, 15, 281. The use of computers for clinical appli- cations in health care is a relatively new idea, and, like any new idea, it must first prove its worth. Many technologies introduced in medicine in recent years have proven, over time, to be ineffective [27]. Physi- cians, nurses, and other health care professionals, therefore, tend to be somewhat cautious in the extent 137