Health Information Management: Integrating Information Technology ...

STARTING POINTS 93
answer the question as the patient phrased it. To translate between patient and
tool requires interpretation by the secretary— and knowledge about what the
tool’s purpose is, and what the meaning of the preset categories is. Similarly,
paramedics responsible for a diagnostic ‘pre-trajectory’ should be able to react
properly to a patient whose situation is such that a test is unlikely to provide
clinically relevant information. It requires much skill to act appropriately in such
situations: knowledge about the test’s purposes, and clinical skills to realize its
inappropriateness.
For the potential synergy between the PCIS and professional work to emerge,
then, the tool’s coordination tasks should not be seen as self-sufficient. In the
common parlance of ‘intelligent agents’ and ‘computerized care paths’, this
imperative is easily forgotten. Yet we already concluded that constantly bridging
the needs of the patient or the work situation and the tool’s or care path’s
demands is a highly skilled activity. It is crucial that the secretary, the
paramedics and other users are supported in this task: through formal training,
but also through the opportunity to constantly learn from and interact with the
other actors in the ‘care chain’. Such ‘lateral connections’ between individuals
that hold seemingly independent positions in the formal ‘workflow’ are essential
to facilitate this articulation work (Brown and Duguid 2000). This comes down
to facilitating physical access to each other, and enhancing unstructured modes
of communication such as e-mail or telephone. This implies not being too rigid
when trying to reduce interferences: when the care path or PCIS controls the
work process so rigidly that the receptionist is no longer in touch with the
specialist, then the former will fail to grasp just what the triage aims to do. Their
tasks may be formally separated: according to a workflow diagram, these two
individuals need not be in direct personal contact with one another. But without
adequate and unstructured contacts between the two, they lose the opportunity to
inform and learn from each other. These are simple things that may seem
insignificant in the light of the larger organizational changes that the PCIS and
care paths bring. Yet they make the difference between being able or not to
integrate the functionality of these standardizing tools in the ongoing flow of
work. Thereby, they make the difference between an innovation that clashes with
that flow of work, and an innovation that lifts professionals’ work to a higher
level.
CONCLUSION
In this chapter, we greatly increased the stakes. This was nothing more or less
than a highly ambitious—yet necessary—requirement specification for the
redesign of care delivery at the level of the actual care processes. This redesign is
necessary because it is the only way to ensure high quality of care without
sacrificing one dimension (say ‘effectivity’) to another (say ‘efficiency’). It is
ambitious, because concrete, successful examples of similar attempts are hard to
find in Western health care practices. A systematic approach such as proposed