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The greatest barrier to realizing network computing's full potential is the same barrier that has hampered the spread of enterprise computing: persuading physicians to use these technologies. Historically, the physician has been the principal integrator of knowledge in health care. It will take a great deal of persuading to convince skeptical, time-famished clinicians that after all the broken promises of the past two decades, network computing actually can simplify and strengthen their practices. This is somewhat of a generational issue, since for most clinicians under age thirty five, using network computing to acquire information and to communicate is as natural as breathing.
The lack of trust is even more a problem with physicians than with consumers. All too often, information technology has been imposed on physicians "from above," by alien, imperial powers (hospitals, health systems, or health plans). Vendors and information managers frequently encounter physicians' fear that information systems will be used to profile them, gather information about their practices, and discipline them or deprive them of income. It is difficult to imagine a situation less conducive to the enthusiastic uptake of a new technology than one that consumes tremendous time and energy in its adoption, while simultaneously threatening the autonomy or livelihood of the user.
However, there are persuasive reasons for physicians to adopt network computing, including the ability to increase the ease of consultation on complex cases, to reduce wasted time and effort in connecting with colleagues and patients, and to improve patient safety. Already, enterprise IT systems have demonstrated their ability to help physicians reduce adverse drug reactions.8 Combining enterprise systems with Internet connectivity to physicians' offices, pharmacies, and pharmacy benefit management (PBM) firms could alert physicians to potential drug interactions and increase patients' compliance with drug therapy.
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