By the mid 1960's the abilities of computers had been recognized by some health care institutions. Health care institutions began to include patient care applications in their computer systems (Saba, Johnson, & Simpson, 1994). An ambulatory care system, Computer Stored Ambulatory Record (COSTAR) system was developed in the late 1960's at Massachusetts General Hospital for the prepaid Harvard Community Health Plan. Patient care data was computerized to meet providers' medical, financial, and administrative needs (Saba & McCormick, 1986). In 1968 was the development of the PRoblem Oriented Medical Information System (PROMIS*) was started (McNeill, 1979). It was the first attempt to provide a total, integrated system that included all aspects of health care including patient treatment.