Research Article Open Access Pearce, J Gen Pract 2013, 1:3 DOI: 10.4172/2329-9126.1000121 Review Article Open Access Volume 1 • Issue 3 • 1000121 J Gen Pract ISSN: 2329-9126 JGPR, an open access journal Keywords: Electronic health records; Computers in general practice; Change and adoption; Primary care; Complex adaptive systems Background Understanding the why behind change allows us to better plan and implements change in the future. For this reason the literature on change, and change management, is vast and never ending. Yet no particular model of change suits all situations, and no situation is perfectly suited to a particular change model. Teory construction about change varies from the personal to the structural and the sociological. Maslow’s hierarchy of needs is an example of the frst [1], structuration theory the second [2], and Habermas’ theory of communicative action the third [3,4]. Te use of social theory allows a deep understanding of the underlying social forces at work, with a view to applying those understandings to diferent settings. Tis paper’s aim is to take an established theory, Complex Adaptive Systems (CAS) and applying to a hitherto untheorised (but not unresearched) area, the adoption of computers in primary care. It uses as a case study the uptake of desktop clinical information systems (CIS) in Australia in the period 1995-2005, a period in which general practitioner computerization went from efectively nil to 100%. What made many thousands of individual, unconnected practices adopt computers, and what might others learn from this? Tis paper will describe the principles of CAS, and then the adoption of computer systems within Australia, and then explore the linkages. Complex Adaptive Systems Isaac Newton was the frst to propose that the natural world was like a great big clockwork entity, a place that can be broken down into constituent parts and problems analyzed successfully [5]. Tis ‘machine like view’, whilst popular during the age of enlightenment, has been inadequate to describe the many complexities of any society. Analyzing change as seen in the real world required new theories to be developed, and CAS is one of these and has been well established as a way of thinking about health [6]. CAS moves away from the view that organizations are like machines, and proposes a more nuanced view of organizational activity. CAS suggests that it is the relationships between the parts that have signifcance, and any change must be related to the whole system, rather than the parts. Such a theory allows that the parts are self- motivating, and are, or can be, responsive. At its most succinct, the principle underlying CAS theory is this: simple agents following simple rules [can] generate amazingly complex structures [7,8]. An analogy to understand this is to look at the process of birds forming a fock. Te traditional understanding is that there is a leader, a champion, and the birds are following the leader. Such ‘champion’ theory pervades change management theory as well. Tis theory suits the hierarchical model that dominates much management and hospital thinking. However, One study showed that flocking behaviour could be modeled using three simple rules for each individual bird in the fock [9]: 1. Each bird must maintain a minimum distance from other objects in the environment, including other birds. 2. Each bird must match velocities with other Birds in the neighbourhood. 3. Each bird must move towards the perceived centre of mass of the Birds in the neighbourhood. When each Bird follows these rules, you get a fock. Tere is no leader, no overall plan, and no ‘collective intention’. No individual bird necessarily understands the concept of the ‘fock’ of which it is part. Nevertheless, these rules, operating individually and at an entirely local level, are sufcient to produce globally coherent patterns that look as if someone, or at any rate something, is directing them. So, it is the relationships that exist between each bird, and the simple rules that apply, that create a complex, yet beautiful system. Te central thesis is that complex systems consist of elements following simple rules, unaware of the complexity they are producing, and making no reference to any centralized blueprint. Yet complex systems they do produce. In addition to these rules that the individual in the system follow is *Corresponding author: Christopher Pearce, Associate Professor, Director of Research, Inner East Melbourne Medicare Local, 10 Lakeside Drive, East Burwood 3151, Australia, Tel: 8822 8844; Fax: 8822 8550; E-mail: chris.pearce@monash.edu Received May 31, 2013; Accepted August 12, 2013; Published August 16, 2013 Citation: Pearce C (2013) The Adoption of Computers by Australian General Practice – A Complex Adaptive Systems Analysis. J Gen Pract 1: 121. doi: 10.4172/2329-9126.1000121 Copyright: © 2013 Pearce C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The world is slowly moving to an E-Health environment. Computers are becoming an essential part of how health is delivered, just as they are a part of all other aspects of life. Yet the adoption of computers is patchy. In some jurisdictions it is the hospital sector that is highly computerized, and in others it is primary care. This paper examines the adoption of computers in general practice in Australia, and provides a theoretical explanation for the reasons general practices adopted computers, while hospitals did not. The application of Complex Adaptive Systems not only explains the computerization, but provides lessons for others in promoting computers in the health sector. The Adoption of Computers by Australian General Practice – A Complex Adaptive Systems Analysis Christopher Pearce 1,2 * 1 Director of Research, Inner East Melbourne Medicare Local, Australia 2 Adjunct Associate Professor, Monash University, Australia J o u r n a l o f G e n e r a l P r a c t i c e ISSN: 2329-9126 Journal of General Practice