Health Information Management: Integrating Information Technology ...

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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
94 MEETING THE CHALLENGE here is rare. This is not surprising: the cultural and organization changes that this would yield are enormous, and great efforts would have to be invested in standardizing care paths, introducing process-supporting ICT, and restructuring care trajectories. Without a redistribution of tasks, however, redesigning care paths cannot go very far. Without ICT, also, the more ambitious goals remain unreachable. Without proper standardization of care paths, finally, thorough redesign is impossible, and quality systems can only stumble along. How can we realize these ambitious aims? In the following chapters, constituting part II of the book, we will attempt to give you some more practical ‘do’s’ and ‘don’ts’ with which to address the information management challenge in your work environment. DISCUSSION QUESTIONS Do you feel the terminology of ‘the chasm’ between the quality delivered and the quality potentially delivered by the health care system is useful? Given the existence of the quality chasm, generate a list of five ICT priorities that your health care organization should set. Given the existence of the quality chasm, generate a list of five ICT priorities that your countries’ health care system should set. Find and discuss a case where the principles discussed here are (explicitly or implicitly) put to practice. What are the lessons learned, and does this case indeed deliver what it promised? NOTES 1 See Chapter 1 on the difficulties of making these organizational changes, or the impact of these ‘redistributions’ on professional relations and so forth. 2 Thanks to Mario Stefanelli for this phrasing. REFERENCES Brown, J.S. and P.Duguid (2000) The Social Life of Information. Cambridge: Harvard Business School Press. Chassin, M.R., R.W.Galvin and the National Roundtable on Health Care Quality (1998) The urgent need to improve health, Journal of the American Medical Association 280:1000–5. Collen, M.E. (1995) A History of Medical Informatics in the United States, 1950 to 1990. American Medical Informatics Association. Committee on Quality of Health Care in America (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press.
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Health Information Management Integ
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Contents List of illustrations vii
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Illustrations FIGURES 3.1 Medicatio
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Contributors Marc Berg is a physici
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Series preface In almost all Wester
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Acknowledgements I would like to th
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Chapter 1 Introduction In all Weste
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INTRODUCTION 3 touch upon the deplo
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INTRODUCTION 5 can draw upon to mai
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INTRODUCTION 7 Physician Order Entr
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Part I Starting points Understandin
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WAITING FOR GODOT 11 KEY TERMS ■
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WAITING FOR GODOT 13 Netherlands an
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WAITING FOR GODOT 15 facts to show
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WAITING FOR GODOT 17 (Lewinski-Corw
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WAITING FOR GODOT 19 In most cases,
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WAITING FOR GODOT 21 (Anonymous 191
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WAITING FOR GODOT 23 Because of the
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WAITING FOR GODOT 25 they simply sa
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WAITING FOR GODOT 27 expected. Stil
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WAITING FOR GODOT 29 organize their
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WAITING FOR GODOT 31 performance in
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WAITING FOR GODOT 33 different HIS
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WAITING FOR GODOT 35 CONCLUSION: TH
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WAITING FOR GODOT 37 assumption tha
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WAITING FOR GODOT 39 Anonymous (191
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WAITING FOR GODOT 41 Berg, M. (1997
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Page 96 and 97: STARTING POINTS 81 ‘gender, race,
Page 98 and 99: STARTING POINTS 83 Now, imagine an
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Page 110 and 111: STARTING POINTS 95 Kohn, L.T., J.M.
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Page 116 and 117: DESIGNING INTERACTIONS 101 1 Identi
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STRATEGY, IMPLEMENTATION AND EVALUA
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Chapter 9 Implementing information
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IMPLEMENTING INFORMATION SYSTEMS 16
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Index accumulation 53-4, 61, 73-4,
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INDEX 223 contingent and emergent c
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INDEX 225 satisfaction 176 patient
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INDEX 227 support 164 technology de
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