Kelly White, RN, BSN, CNOR, is surrounded by computer monitors. A wall-mounted plasma screen above her for patient tracking. A computer on wheels - or COW, as it's known - for perioperative charting to her the right. And a PC notebook in her hands for live look-ins at her six inpatient ORs and four outpatient ORs.

"Physicians cannot believe how high-tech we are," says Ms. White, the divisional director of surgical services at Medical Center Hospital in Odessa, Texas. Her hospital has spent nearly half a million dollars ($458,000) on the software and some of the hardware to automate surgical services. The goal is for the entire hospital to be paperless by 2008.

And you're sitting there trying to figure out how to attach a Word document to an e-mail message.

And I'm sitting here trying to open the Word doc you just e-mailed me. Hey, I've got mail.

Welcome to surgery's Great Digital Divide. Those with T1 lines and IT staffs and PDAs to the right. All pen-and-paper pushers and slow adapters who don't know AdvantX from iPod to the left.

The OR software survey we conducted last month made one thing clear: Automation is a love-hate thing. Nearly as many of our 280 panelists (about 30 percent) are very dissatisfied with their software packages as are those who are very satisfied. About nine in 10 of our responders use software to manage some element of their facilities - mostly case scheduling and preference cards - but a good portion of them have yet to master it. As you'll see in "OR Management Software Survey" on page 36, it's as if they've got a tiger by the tail.

Take perioperative charting, for example. Nearly one-third (31 percent) of our panelists are dissatisfied with their charting programs. When we asked why, there was plenty of blame to go around, most of it aimed at stubborn staff, surgeons and software.

Since Medical Center Hospital installed COWs in every OR for charting three years ago, not only is the accuracy and legibility of the charting much improved, says Ms. White, but the very nurses who once resisted the paperless push now huff and puff when the COWs are temporarily down (out to pasture?) and they have to write things down rather than point and click.

Ms. White's best tip: Go slowly. Phase in the software by function (you might first automate scheduling and then move on to patient tracking), by area (first the ORs, then pre-op, then post-op) and by staff (shift by shift; recruit a couple super-users to advance the cause).

"It can be intimidating for staff, especially those who are not computer literate," says Ms. White.

Up next for the hospital's surgical services department: a charge master interface and an upgrade. Hello, help desk?