Making clinical informatics work

Don't forget the doctor is the customer

The introduction of new technology into medicine has been limited by cost and ethical considerations rather than doctors' resistance. Far from being Luddites, doctors have taken a lead in developments. Why then do recent initiatives in health service information systems leave them so cold? The short answer is that doctors regard the current systems, unlike technology that they have embraced, as offering no obvious benefits either for patient care or for their own working conditions.

The information management group of the NHS Management Executive has spent eight years, and about (pounds sterlling)250m, developing and implementing an information strategy for the NHS. Despite this a recent review commissioned by the information management group from CASPE Consulting found that no computing initiative in Britain had successfully married a hospital-wide range of clinical activity with electronic means of recording.

The group's hospital information support system project (HISS)1 has led to systems that, according to the project's director, have “an administrative rather than a clinical bias.”2 These systems often do little to support patient …