The Computer Prescription: Medical Computing, Public Policy, and Views of History

Abstract

This article traces past trends and current developments in medical computing in the United States. It suggests a link between shifts in emphases in medical computing and in federal government policy toward health care delivery. The development of medical computing was not driven solely by the internal imperatives of science and technology, but by dreams and visions of how computers could revolutionize medicine. Such dreams and visions constitute a mythical charter similar to ideologies and rhetoric used to mobilize support by other computerization movements. This mythical charter influenced development of medical computing by tying computing in medicine to policy goals. This charter also affected historical accounts in medical computing, which are characterized by technological determinism and evidence of cognitive dissonance due to failure to achieve policy goals.

Computers, systems theory, and the making of a wired hospital: A history of Technicon Medical Information System, 1964–1987

“…2 Among these problems, perhaps the greatest was the issue of health insurance. For an excellent article discussing the rise of computers in medicine in relationship to government policy (particularly related to insurance), see Kaplan, B. (1995).…”

Pushing the contextual envelope: developing and diffusing IS theory for health information systems research

“…Beall, Golladay, Greenfield, Hensinger, & Biermann, 2002;Zrebiec & Jacobson, 2001), the sociology of medicine (cf. Kaplan, 1995;Kaplan & Lundsgaarde, 1996), diffusion of medical technologies (cf. Kumar & Motwani, 1999), information systems (cf.…”

Cakes for cure: the role of charities in the embedding of innovative cancer treatment technologies

“…The IGRT is placed within an existing and widely accepted framework of ideas, values and practices (most of the potential donors will have had some experience of radiotherapy either directly or indirectly through a family member) and the mythical charter, like that discussed by Kaplan, can be found in the rhetoric used by the charities where policy and life aspirations are projected onto the technology 13 . However, Kaplan warns that systems based on a Ômythical charterÕ embody the goals and values of the groups which create that charter and not necessarily those shared by the practitioners (or users of the systems).…”

“…The charities enable any discussion regarding IGRT to be located in a discourse that is meaningful to lay publics. Where this discourse takes place and the rhetoric used in the discussions contributes to the progression of the technology into practice 13 .…”

“…In the context of this study, the programme loyalists could be considered to be charitable groups; and the producers of knowledge could be those working in the practices the IGRT is said to enhance, the practitioners. Kaplan, in her history of medical computing, found that proponents of the US electronic patient records promoted benefits of the systems as irrefutable 13 . In an historical analysis, she found that once sceptical doctors were, 10 years later, professing medical computing as the way forward.…”