Almost all British general practitioners use computers in their consulting rooms, but most hospital doctors do not. Over 30 years, leaders of the GP profession worked with government to provide incentives for computerising practices and to remove barriers. In hospitals computing was treated as a management overhead, and doctors had no incentives to become involved. The success of the government’s plans for “joined up” computer based health services depends on providing appropriate incentives to hospital doctors. GP computerisation has been a success, but what works in a GP surgery does not readily scale up to work in a hospital. Computer-based patient records have a more diverse range of uses in hospitals than in general practice, and simple unidimensional classification schemes such as the original Read codes cannot cope. In hospitals, many different computer systems need to be linked together, requiring common interoperability standards. Protection of privacy is a greater problem in hospitals, and the number of potential users makes greater demands on hardware and networks.
Benson T. Why general practitioners use computers and hospital doctors do not—Part 1: incentives and Part 2: scalability. BMJ 2002; 325: 1086-1093