Computers and clinical judgment: the role of physician networks

In order to study the relationship between physician networks and utilization of a computer-based hospital information system (HIS), blockmodel analysis and multidimensional scaling were used to analyze and spatially represent the network of professional relations among 24 physicians in a private group practice. A blockmodel analysis of patient referrals, consultations, discussions, and on-call coverage identified four groups of physicians who share common locations and perform similar roles within the network. Investigation of the shared attributes of these groups supports this relational structure. The results suggest that the center-periphery model of diffusion of new ideas among professionals may be too simplistic. Instead, the communication network may involve multiple central cohesive subgroups of physicians who differentially initiate patient referrals and consultations with physicians in other subgroups. Network location was found to have a significant effect on the adoption and utilization of the HIS independently of background and practice characteristics of physicians. The results also suggest that adoption of an innovation and its implementation or utilization may involve separate processes that need to be differentiated in future research.