John H. Greist
Marjorie H. Klein
IN the five years since we wrote Computers in Psychiatry, Promises to Keep, 74 cross currents of advances in computing technology and legislation mandating and regulating mental health services, payments and research, and professional attitudes have produced some striking successes in this field, as well as a simultaneous turbulence that makes future directions far from certain. Few clinicians, fewer patients, but perhaps more administrators, interact directly with computers. Most contacts have negative connotations: There is the obligation to complete forms to feed the computer, and the requirement of paying bills. It is thus still appropriate to ask whether computers have an important role in psychiatry beyond the standard fiscal and administrative services that can be adapted from business applications. Often, these fiscal services are purchased from Computer Service Bureaus, which also serve a wide variety of nonmedical business applications. Psychiatric computing remains at some distance from the promised land of integrated and demonstrably useful administrative and clinical computing services that we have been traveling toward for the past two decades.
Technologies that succeed quickly and broadly solve critical problems. Often they represent first-time solutions (for example, the Salk polio vaccine) and markedly increase the quality and/or quantity of a service in a cost-effective or cost-efficient manner (for example, banking, credit card, and airline reservation services). For computers to gain a permanent franchise in psychiatry, they must address and solve important problems. They must also enter, or sometimes create, a receptive atmosphere or else they must wait for a hostile atmosphere to change. There are those who feel that many computer applications are unjustified intrusions into the humanistic practice of psychiatry. 130 Computer applications apparently represent