multiprocessor environments, a configuration that arises in response to a hospital's demands for flexible implementation and system expandability. This trend can be expected to continue. All but one of the systems are designed to run on the hardware of a particular vendor; the exception is a system adaptable to any hardware that uses UNIX. For the most part, the systems described in the survey do not employ the most advanced terminal technologies, even though these technologies are no longer new on the market. The one exception to this generalization—the vendor whose product is adaptable to many different types of computer hardware—supports both windowing and point-and-click technologies.

FINDING 3. System costs, including installation, are likely to be in the range of $2 million to $6 million for a medium-sized hospital. Annual maintenance costs for each system could be substantial—approximately 10 percent of the purchase or lease price.

FINDING 4. With the exception of a single software vendor, the industry is moving slowing in solving one crucial problem: ease of data entry. Although such devices as the mouse and the light pen are commonly used in other industries, and even in home computing, they are rarely found in health care computing. The only vendor that offers evidence of having solved the problem of convincing physicians and nurses to use the system is the same vendor that has exploited these technologies most fully. The same conclusion may be drawn with regard to flexible output devices: the vendor that offers the most flexible data entry methods also supports the most varied output, including terminal windowing, and has the most flexible hardware requirements.

FINDING 5. The survey responses are informative regarding vendor attitudes toward the state-of-the-art in CPR systems, but they may not be helpful in defining the actual state-of-the-art. The committee found it surprising that the software vendors who responded to the survey should so heavily emphasize hardware improvements as the necessary step in advancing to comprehensive CPRs and CPR systems.

FINDING 6. The last set of findings was based on a group of open-ended questions to which only a few vendors responded. In general, they seem reluctant to lay out in detail imaginative ideas regarding the impact of computerized systems on the industry their systems are intended to serve, namely, the health care industry. Thus, the committee found it disturbing that the vendors appeared pessimistic, perhaps unintentionally, about surmounting the difficulties involved in implementing the CPR—especially given the success that some have had in overcoming certain technological and behavioral problems associated with CPR implementation.

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