Health Information Management: Integrating Information Technology ...

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INTRODUCTION 3 touch upon the deployment of IT in the organization—whether at the strategic or the implementation level. A READER’S GUIDE This book focuses on what we call ‘Patient Care Information Systems’ (PCIS): all those systems that are used primarily by health care professionals and patients, and that are primarily oriented at the support of their tasks (such as electronic patient records, order communication systems, patient cards, patient information systems). Systems that bridge the primary care process and secondary work processes in health care organizations, such as management information systems and registration systems for scientific research are included. Systems that primarily focus on financial administration, human resource management and so forth are not addressed here. This is not an ordinary handbook. Significant parts of this book are not written in the form of ‘how to’ manuals, but are aimed at providing an understanding of the tasks of information management; of the organizational processes and management of design, implementation and evaluation of PCISs. Subsequently, these and other chapters also give concrete guidelines for (information) managers and professionals to handle these tasks. We argue, maybe a bit counter-intuitively, that those readers whose responsibilities are not primarily oriented towards information management concentrate first and foremost on the more conceptual chapters. A core insight of this book is that many PCIS projects run to the ground because of wrong expectations of what these technologies can do (at the level of the workfloor and for the organization), and how their implementation should be managed. The book touches upon the familiar high hopes and dreams surrounding information technology, and the frustrations of professionals when these high hopes cannot be realized instantly (‘my nephew can do this in one evening!’). Since the conceptual chapters are full with concrete examples and are directly oriented towards the real-life issues that managers and professionals face in their daily, information-intensive work, these chapters (concentrated in Part I of this book) are not ‘difficult’ or ‘dry’. Part I, then, ‘Understanding health care work and the role of IT’ attempts to underscore the strategic importance of IT, the nature of IT and its development, and the nature of health care work. It will push the reader to understand the phenomenal challenges of creating true synergy between health care work practices and PCIS systems. Simultaneously, it will set high stakes for the ambitions that can and will have to be pursued in twenty-first century health care. Chapter 2 focuses on the nature of information technology innovation. Through a historical account of the paper-based patient-centred record, and the subsequent quest for its electronic sequel, the entanglement of information technology, information management and its social and organizational context is emphasized.
4 INTRODUCTION Subsequently, Chapters 3 and 4 deal with the nature of health care work and of health care information, and with the way PCIS systems can transform this work. This transformation, we will argue, can easily be a negative development: systems abound that truly ‘interfere’ with work rather than support it. Only through a thorough understanding of the nature of health care work and information can systems be developed and implemented that can help this work become more patient-oriented, more effective, more efficient, and more professional-oriented. This last sentence, we will argue in Chapter 5, is no mere slogan. Western health care is in dire need for means to cross the ‘Quality Chasm’, as it has been labelled by recent, widely embraced reports from the US Institute of Medicine (Committee on Quality of Health Care in America, 2001). Information technology, we will argue in Chapter 5, is a sine qua non in the effort to transform health care work so that it can hope to meet the challenges facing it. Crucially, however, IT will not be able to fulfil this role in the form of yet the next IT ‘hype’. It is not more intelligent technology that we need: it is intelligent use of already existing technologies. As will become abundantly clear in this chapter and others, properly developing and implementing IT in health care practices is primarily about organizational development. Technology is crucial— but secondary. In Chapter 6, this latter theme is picked up again in a discussion about the proper position of Information Technology in the interaction space for humans in complex organizations such as hospitals. This chapter challenges us to see even the design of systems as a shift from a focus on the technology to the people that are using it. Only in that way, the chapter argues, can information systems become truly useful. In Part II, ‘Information strategy, implementation and evaluation’, we will build upon these insights and discuss some of the information management tasks. Here, we will dive deeper into the topics of IT strategy development, PCIS implementation and PCIS evaluation. More than in Part I, the emphasis is directed towards providing practical guidelines for the health information manager. Chapter 7 discusses the challenges of information strategy development. It discusses the very nature of strategy and strategy formation, and it focuses on the alignment between the information strategy and the organizational strategy. The complexity of both information technology and health care organizations, the chapter argues, makes the attempt to align their mutual development a sheer impossible—yet crucial! —challenge. Chapter 8, subsequently, sets out to give the reader some concrete instruments with which he/she can manage this process. It discusses the goals of the information strategy, gives guidelines to how it should be drafted, and, more importantly, what it should contain. These instruments do not solve the complexity, nor do they constitute a simple roadmap towards success. Yet they are the tools that health information managers—and health care organizations—
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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
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Page 24 and 25: Part I Starting points Understandin
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Page 56 and 57: WAITING FOR GODOT 41 Berg, M. (1997
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HEALTH CARE WORK AND INFORMATION SY
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THE CONTEXTUAL NATURE OF INFORMATIO
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Chapter 5 Meeting the challenge Int
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STARTING POINTS 81 ‘gender, race,
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STARTING POINTS 83 Now, imagine an
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STARTING POINTS 85 organization,
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STARTING POINTS 87 Figure 5.2 Incre
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STARTING POINTS 89 already overflow
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STARTING POINTS 91 responsibilities
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STARTING POINTS 93 answer the quest
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STARTING POINTS 95 Kohn, L.T., J.M.
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Chapter 6 Designing interactions En
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DESIGNING INTERACTIONS 99 the way t
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DESIGNING INTERACTIONS 101 1 Identi
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DESIGNING INTERACTIONS 103 the deve
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DESIGNING INTERACTIONS 105 communic
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DESIGNING INTERACTIONS 107 Figure 6
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DESIGNING INTERACTIONS 109 ■ Figu
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DESIGNING INTERACTIONS 111 measurem
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DESIGNING INTERACTIONS 117 Covell D
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Part II Information strategy, imple
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INFORMATION STRATEGY: AN INTRODUCTI
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Chapter 8 Developing the informatio
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STRATEGY, IMPLEMENTATION AND EVALUA
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Guidelines for information system d
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Chapter 9 Implementing information
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IMPLEMENTING INFORMATION SYSTEMS 16
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Chapter 10 Project management of in
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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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