Abstract
The record of applying computer‐based information systems in the NHS has been poor, as demonstrated by a National Audit Office report published in 1990. Now, there are fresh demands for information arising from reform of the health service, and short‐term pressures for organizational change as decreed by the White Paper ‘Working for Patients’. If the benefits of reform are to be realized in the form of executive information systems, there is a need to understand more clearly the nature of the management system and how innovations spread.