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Abstract
The National Health Service (NHS) has entered a new world of managed competition, where the purchasing and provision of services are formally separated. Accompanying the changes are major investments in computer systems, which will continue for at least the first half of the 1990s. However, the performance of the NHS in implementing computer systems has been variable, so that now is an appropriate time to review the current status of NHS computing, and to consider the key issues for computing in the new environment.