Health Information Management: Integrating Information Technology ...

90 MEETING THE CHALLENGE
PCIS abides by the decision criteria, terminology and work procedures that are
formalized and explicated in the PCIS. As we argued in Chapters 3 and 4, more
powerful ICT functionality requires more alignment of the professionals’
activities with the PCISs’ demands. If the PCIS alerts a physician about a task
that now has to be done, he or she should be able to trust that the activities that
led up to this alert were indeed properly executed as agreed. If the PCIS should
support health care workers in making decisions, in addition, the health care
workers have to use the basic algorithms and terminology the PCIS draws upon
to properly interpret its advices. Only by ‘preprogramming’ into the PCIS which
patients have to be dealt with how, can more coordination tasks be delegated to
the PCIS.
A keen redesign would also maximally reduce the need to disrupt each other’s
ongoing work activities to announce or request something (see Chapter 6). For
every outsider observer, this incessant flow of interruptions is astonishingly
inefficient—yet a health care professional’s working day is often more typified
by the constantly ringing phone, beeper and colleagues dropping in than by the
ability to actually concentrate on the work that needs to be done. On the one
hand, these constant interruptions are part and parcel of the ‘unpredictable’
nature of health care work, and cannot (nor should) thus ever be completely
avoided (see further). Yet smartly restructuring the task divisions, and using the
PCIS, may importantly reduce such interruptions. Tasks can be made more
independent when optimally sequenced, and, moreover, those later on in the
process can be more fully informed through the PCIS about the steps that went
before. In addition, more asynchronous modes of communication (more informal
such as e-mail, but also highly structured such as through a care path’s template)
can be used to facilitate communication.
Ideally, the redesign should be based on information about the ‘performance’
of the care path (in terms of health outcomes, efficiency, patient satisfaction,
safety and so forth). Also, once in place, the effect of the new organization
should be equally measured. This improvement process should, in principle, be
continuous: new data analysis leading to new innovation needs, requiring new
redesigns and new measurements, and so forth. This is the principle of continuous
quality improvement, or performance management (see Walburg forthcoming).
Having standardized care paths greatly facilitates these processes of continuous
improvement. Data registration becomes more uniform (since the care paths are
more alike), and may also become more extensive (see also below). In addition,
the standardized care paths themselves form the framework for the interpretation
of the gathered data: they are, after all, guidelines that link the data that would
otherwise remain difficult to integrate. Finally, these guidelines can also suggest
proper outcomes to monitor, and/or performance levels that may be taken as
target for the professionals.
Standardization is necessary, but only there where it enhances competencies
and quality rather than reduces it. In the alternative scenario, receptionists’ and
nurses’ tasks are highly standardized. Yet they received new tasks and