Health Information Management: Integrating Information Technology ...

More documents

Recommendations

Info

IMPLEMENTING INFORMATION SYSTEMS 173 and so forth), each consisting of up to 30 individual screens. All in all, the system consisted at that time of 27,000 different screens (Goorman and Berg 2000). A core problem of the system encountered in this case study, not unlike the labyrinth of authorization levels mentioned above, was that the number of screens was exploding beyond manageability. Dedicated to their previous work environments and colleagues, the implementation team dutifully translated each request and ‘need’ from the hospital’s shop floor into a new screen. This is only one example of a common problem in projects that have users ‘in the lead’: the trajectory of user-led design processes tends to lose direction and momentum due to the multitude of different voices pushing the process into different directions— or to nowhere at all. In health care settings, usually characterized by a host of different professional, paraprofessional, technical, administrative groups and so forth, this problem is even more pronounced. The balancing act between user-directedness and manageability, then, between the need to be ‘flashy’ and to be ‘robust’, or between the needs and desires of different usergroups can only be made when the users’ presence in the project group is itself balanced by a proper and strong presence of upper management. Overall, the project group should lie out a vision that creates and restricts the space within which user-involvement can emerge and can express itself. This requires the existence of that vision at the level of the upper management, and the adequate operationalization of that vision into adequate means, mandates and manoeuvring space for the project group. This vision, which should be first and foremost about the future of the organization (maybe inspired by IT possibilities, but not primarily centred around IT) should be both robust enough to frame and direct the PCIS implementation process, yet it should be openended enough to be adaptable to newly upcoming challenges, in part deriving from the PCIS implementation process itself. In the next subsection, we will take a deeper look at the need for this flexibility, and at the core insight that organizational development—including PCIS implementation—is more about improvization and organizational learning than about top-down planning and ‘process redesign’. Myth 3: PCIS implementation can be planned, including the required organizational redesign Although one can and should intend to have a PCIS development trajectory affect one’s organizational structure and processes, this ‘intention’ should not turn into an attempt to fully plan and control this process. In much literature on IS-related organizational change, business process redesign or re-engineering (BPR) is embraced as the sure route to competitive advantages and organizational survival. Originated in the private sector, BPR, in short, propagates a process
174 STRATEGY, IMPLEMENTATION AND EVALUATION view of organizations, in which the whole organization is organized around the customer and the product he desires, rather than the traditional functional view, in which the organization is organized around its core, internal functions. BPR states that managers should be willing to radically redesign business processes so as to optimize the processes’ effectiveness and efficiency. Translated into health care idiom, an organization’s ‘core business’ is the primary care process (the work of health care professionals to manage patients’ trajectories). The necessary redesign is usually taken to be the creation of PCIS-dependent integral care delivery systems, radically restructuring the traditional, ‘functionally organized’ health care organizations. These ultimate aims are crucial, and the ambitions explicated in Chapter 5 are deeply influenced by these views. Also, it is an important insight that it is not possible to maximize IT’s contribution to organizations without affecting the very nature of these organizations. Yet the idea that current business processes (including current information systems) should be radically redesigned from scratch, and that this should be done top-down, is simply wrong. In strictly hierarchically oriented companies, where the processes to be redesigned are relatively predictable and standardized, such an approach might be feasible. In such instances, senior management can simply impose wholly new working routines and cooperation patterns on its employees. In health care, however, the ‘core business process’ consists of highly knowledge-intensive, professional work, typified by a complexity that defies the predictability and standardization required for simple reengineering. Moreover, the professionals ultimately responsible for this process are powerful actors in the organization, and cannot be simply told to change their work patterns by senior management. It all adds up: the complexity of the primary care process, the complexity and unpredictability of the IS itself and the sheer number of parties involved in PCIS implementation (see Myth 2, p. 180) results in a process which is fundamentally unfit for a strict planning and controlling approach. The uncertainty and unpredictability of PCIS implementation processes is an inherent characteristic of such processes, which should be accepted and even nurtured rather than ‘overcome’. Attempting to impose more controls to weed out surprises is a sure route to disaster: unexpected problems should be taken as instances to learn from and adapt to rather than as obstacles to overcome. Similarly, unforeseen spontaneous alternative uses of the system should be carefully investigated as possible unexpected ways to draw out unforeseen benefits from the system (Ciborra 1997). CASE VIGNETTE In a study of an electronic patient record developed for use in the care for hypertensive patients, for example, we found that the designers, in close cooperation with one or two leading hypertensive specialists, had opted for a very structured interface. The record consisted of several screens in which doctors could enter (coded) complaints, diagnosis, blood pressures, examination
Page 2 and 3:
Health Information Management In al
Page 4 and 5:
Health Information Management Integ
Page 6 and 7:
Contents List of illustrations vii
Page 8 and 9:
Illustrations FIGURES 3.1 Medicatio
Page 10 and 11:
Contributors Marc Berg is a physici
Page 12 and 13:
Series preface In almost all Wester
Page 14 and 15:
Acknowledgements I would like to th
Page 16 and 17:
Chapter 1 Introduction In all Weste
Page 18 and 19:
INTRODUCTION 3 touch upon the deplo
Page 20 and 21:
INTRODUCTION 5 can draw upon to mai
Page 22 and 23:
INTRODUCTION 7 Physician Order Entr
Page 24 and 25:
Part I Starting points Understandin
Page 26 and 27:
WAITING FOR GODOT 11 KEY TERMS ■
Page 28 and 29:
WAITING FOR GODOT 13 Netherlands an
Page 30 and 31:
WAITING FOR GODOT 15 facts to show
Page 32 and 33:
WAITING FOR GODOT 17 (Lewinski-Corw
Page 34 and 35:
WAITING FOR GODOT 19 In most cases,
Page 36 and 37:
WAITING FOR GODOT 21 (Anonymous 191
Page 38 and 39:
WAITING FOR GODOT 23 Because of the
Page 40 and 41:
WAITING FOR GODOT 25 they simply sa
Page 42 and 43:
WAITING FOR GODOT 27 expected. Stil
Page 44 and 45:
WAITING FOR GODOT 29 organize their
Page 46 and 47:
WAITING FOR GODOT 31 performance in
Page 48 and 49:
WAITING FOR GODOT 33 different HIS
Page 50 and 51:
WAITING FOR GODOT 35 CONCLUSION: TH
Page 52 and 53:
WAITING FOR GODOT 37 assumption tha
Page 54 and 55:
WAITING FOR GODOT 39 Anonymous (191
Page 56 and 57:
WAITING FOR GODOT 41 Berg, M. (1997
Page 58 and 59:
Chapter 3 Health care work and pati
Page 60 and 61:
HEALTH CARE WORK AND INFORMATION SY
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
THE CONTEXTUAL NATURE OF INFORMATIO
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Chapter 5 Meeting the challenge Int
Page 96 and 97:
STARTING POINTS 81 ‘gender, race,
Page 98 and 99:
STARTING POINTS 83 Now, imagine an
Page 100 and 101:
STARTING POINTS 85 organization,
Page 102 and 103:
STARTING POINTS 87 Figure 5.2 Incre
Page 104 and 105:
STARTING POINTS 89 already overflow
Page 106 and 107:
STARTING POINTS 91 responsibilities
Page 108 and 109:
STARTING POINTS 93 answer the quest
Page 110 and 111:
STARTING POINTS 95 Kohn, L.T., J.M.
Page 112 and 113:
Chapter 6 Designing interactions En
Page 114 and 115:
DESIGNING INTERACTIONS 99 the way t
Page 116 and 117:
DESIGNING INTERACTIONS 101 1 Identi
Page 118 and 119:
DESIGNING INTERACTIONS 103 the deve
Page 120 and 121:
DESIGNING INTERACTIONS 105 communic
Page 122 and 123:
DESIGNING INTERACTIONS 107 Figure 6
Page 124 and 125:
DESIGNING INTERACTIONS 109 ■ Figu
Page 126 and 127:
DESIGNING INTERACTIONS 111 measurem
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
DESIGNING INTERACTIONS 117 Covell D
Page 134 and 135:
Part II Information strategy, imple
Page 136 and 137:
INFORMATION STRATEGY: AN INTRODUCTI
Page 138 and 139: INFORMATION STRATEGY: AN INTRODUCTI
Page 152 and 153: Chapter 8 Developing the informatio
Page 154 and 155: STRATEGY, IMPLEMENTATION AND EVALUA
Page 172 and 173: Guidelines for information system d
Page 180 and 181: Chapter 9 Implementing information
Page 182 and 183: IMPLEMENTING INFORMATION SYSTEMS 16
Page 198 and 199: Chapter 10 Project management of in
Page 236 and 237: Index accumulation 53-4, 61, 73-4,
Page 238 and 239:
INDEX 223 contingent and emergent c
Page 240 and 241:
INDEX 225 satisfaction 176 patient
Page 242:
INDEX 227 support 164 technology de
show all

Health Information Management: Integrating Information Technology ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?