This paper examines the use of computing in hospitals and compares this with the use of computing in general practice. In the UK, virtually all GPs, i.e. doctors in primary care, use computers and computer-based records in their care of patients, whereas most doctors in hospitals do not [3, 25]. There are many reasons given for the lower use of computers in hospitals. It has been suggested that hospital medical activities are more complex than those in general practice and that there has been too little investment in hospital information and communication technology (ICT), two truisms. This paper examines and compares the different and contrasting theories that attempt to explain this phenomenum. The paper has relevance to (1) researchers wishing to migrate successful research from a 'research laboratory environment' such as in a medical school to a real-world setting in a hospital or a hospital clinic, (2) medical informatics researchers interested in investigating the problems of ICT implementations in hospitals, and (3) medical informatics practitioners involved in real-world hospital ICT developments.
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