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Investment in information systems has traditionally been justified in terms of productivity or value-added gain. From this point of view the slow rate of adoption of IT in the healthcare sector appears paradoxical because the rapid increase in medical costs has created an urgent need for productivity improvements. Spence's market signal theory may explain why some information system investment decisions are made and may, in part, explains the reluctance of clinicians to embrace informatics. Case studies are presented where we argue that information system investment was made primarily to send a market signal. We call information systems that are used primarily to send a market signal, semaphoric information systems. Characteristics of semaphoric information systems are presented. It is postulated that the therapeutic relationship between doctor and patient is central to current models of healthcare, and that the semaphoric 'message' of the current generation of IT systems may be detrimental to this relationship. This suggests that clinicians will continue to be reluctant to embrace information systems until information systems are developed that can send signals that enhance the doctor-patient relationship.

Can Signalling Theory and the Semaphoric Nature of Information Systems Explain Clinicians' Ambivalence to Informatics?