Evaluating the impact of computer-based medical information systems requires not only an understanding of computer technology but also an understanding of complex social and behavioral processes. This essay discusses the need for evaluation of health care information systems, a set of evaluation questions based on assumptions about the impact of technology on organizations, and recommendations for reducing barriers to the implementation of health care information systems.

CompuHx* is an Interactive Health Appraisal System (IHAPS) used in the examining room at Kaiser-Permanente's San Diego Department of Preventive Medicine to record patient information, assist in diagnosis, and provide a legible summary of findings. The purpose of the present project was to examine the impact of computer use in the examining room on patient satisfaction with the Health Appraisal experience. Survey results showed no significant differences in patient satisfaction between patients whose examiners used CompuHx and those whose examiners did not. These findings indicate that, in the eyes of the patients surveyed, clinician use of a computer in the examining room did not depersonalize their relationship with the clinician, nor did it enhance satisfaction with the thoroughness of the exam or confidence in the examiner's findings.

Professional groups approach the computer implementation process as an opportunity both to protect and enhance their ability to perform their work and to negotiate for arrangements that will further their professional agendas. The article examines and compares the professional agendas and negotiating positions of pharmacy and laboratory departments as examples of professional groups involved in the implementation of order entry systems. Findings showed a stronger stance taken by the pharmacy departments in both institutions to exercise as much control as possible over the order entry process. This stance is influenced by both task issues and professional agendas. Understanding the link between these professional agendas and the issues that arise during computer implementation can help guide similar negotiations as institutions adopt computer-based patient record systems.

CompuHx* is an Interactive Health Appraisal System (IHAPS) used in the examining room to record patient information, assist in diagnosis, and provide a legible summary of findings. This paper describes Phase I of a longitudinal study in which 22 examiners (five system users and 17 non-users) responded to detailed surveys and interviews about the system. Findings indicated that both users and non-users had mixed feelings about the system's ease of use and impact on their jobs, but agreed that it would have value for their practice. Underlying their acceptance of the system was a common concern for maintaining a caring relationship with patients and not allowing computer technology to depersonalize the examining room. Examiners also expressed concerns about the implementation process.

The care trade: a picture of health