“…(34)(35)(36)(37) In addition, implementation difficulties related to installation and usage are being dealt with more effectively and there is currently more awareness, for instance, that the organizational culture presumed during the design of a system must match the actual culture of the implementing organization. (3s, 39) Despite these developments, most clinical records today are still paper-generated and CMRS penetration into the patient-physician session, where the actual medical process takes place and where the bulk of medical information is created, has been rather limited. (4~ In the Nethedands,(41) for instance, by June 1992 "38% of general practitioners had purchased and installed a patient-record module" although the first system was installed in 1978 (p. 1037).…”