Dissemination of COSTAR. Promises and realities.

COmputer-STored Ambulatory Record (COSTAR) is an automated medical record, fiscal management and reporting system, developed in the mid-1970s for use in ambulatory care settings. Its flexibility, full functionality, low cost, and transportability held great promise for wide system dissemination in the 1980s. Reportedly, over 150 health organizations have installed COSTAR worldwide. In reality, this number represents a small fraction of the potential market. Several factors are listed below as contributing to the slower than expected dissemination. Of major importance may be that COSTAR--written in the MUMPS language--could not be installed on IBM hardware. Recently, however, third-party software houses announced MUMPS operating systems that allow COSTAR to run in a multiuser environment on the IBM PC/AT. Developments in the microcomputer field that may impact on the dissemination of COSTAR are described in this paper in addition to early experiences at MITRE with COSTAR on the IBM PC/AT.