Health Information Management: Integrating Information Technology ...

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IMPLEMENTING INFORMATION SYSTEMS 179 by the coming of this new technology, and the technology is in its turn inevitably affected by the specific organizational dynamics of which it becomes a part. This empirical fact can become highly problematic when IS implementation is seen as a mere matter of ‘diffusing’ a technology, or of merely ‘rolling out’ a technical fix. In such instances, ‘barriers’ and ‘obstacles’ appear from the blue in the guise of ‘user resistance’ or suboptimal ‘returns’ of the PCIS. When anticipated, however, when seen as a process of organizational development, PCIS implementations can be strategically intended to transform the organization, and the technology can be allowed to grow along, gradually becoming part and parcel of the basic organizational work routines. We described, likewise, how such a process can only get off the ground when properly supported by both central management and future users. A top-down vision and framework for the implementation is crucial: only with such a framework can ‘user needs’ be articulated that transcend individual wish lists. In setting the stage this way, user-input can become a coherent, steering force that in its turn transforms and specifies the overall vision—and that creates a solid basis for the organizational transformations that will then certainly ensue. Finally, we emphasized how the management of PCIS implementation processes resembles a careful balancing between initiating organizational change, and drawing upon IS as a change agent, without attempting to pre-specify and control this process. It is a balancing act between setting goals and targets for the implementation—yet stimulating the mutual learning processes that will inevitably transform these goals and targets. Accepting, and even drawing upon, this inevitable uncertainty might be the hardest lesson to learn—yet time and time again, the most ‘successful’ implementation processes appear to be those in which an obsession for control and planning is replaced by an obsession for experimentation and mutual learning. It implies finding the difficult balance between setting the direction for change, and to let oneself drift with the current thus formed. Time and time again, the exact role of the PCIS in the organization is only discovered during the implementation process. In the next chapter, we will attempt to translate some of these insights into practical guidelines for project management, the distribution of responsibilities, and the modes in which we can organizationally realize this ‘management of uncertainty’. DISCUSSION QUESTIONS 1 Figure 9.1 describes the interrelation between PCIS, primary and secondary work processes. Select a PCIS you are familiar with, and describe this interrelation. Can you discern synergies? Are there also negative interactions in which the PCIS is involved? 2 Does the critique on lists of ‘success’ and ‘failure’ factors imply that such lists are useless?
180 STRATEGY, IMPLEMENTATION AND EVALUATION 3 Explain the following seeming paradox: ‘not changing the success criteria for one’s technology is a certain sign of failure’ (after Latour 1996). NOTE 1 Atkinson and Peel use a much more ‘peaceful’ metaphor when they speak of ‘growing’ rather than ‘building’ information systems (Atkinson and Peel 1998). REFERENCES Ash, J.S., P.N.Gorman, M.Lavell, T.H.Payne, T.A.Massaro, G.L.Frantz and J.A. Lyman (2003) Physician order entry: a cross-site qualitative study, Journal of the American Medical Informatics Association 10:188–200. Atkinson, C. and V.J.Peel (1998) Growing, not building, the electronic patient record system, Methods of Information in Medicine 37:285–93. Ciborra, C.U. (1997) Improvising in the shapeless organization of the future. In C.Sauer and P.W.Yetton (eds), Steps to the Future: Fresh Thinking on the Management of IT- Based Organizational Transformation. San Francisco: Jossey-Bass, pp. 257–78. Ciborra, C.U., K.Braa, A.Cordella, B.Dahlbom, A.Failla, O.Hanseth, V.Hepso, J. Ljungberg, E.Montiero and K.A.Simon (eds) (2000) From Control to Drift. The Dynamics of Corporate Information Infrastructures. Oxford: Oxford University Press. Glaser, J.P. and L.Hsu (1999) The Strategic Application of Information Technology in Healthcare Organizations. Boston: McGraw-Hill. Goorman, E. and M.Berg (2000) Modelling nursing activities: electronic patient records and their discontents, Nursing Inquiry 7:3–9. Hartswood, M., R.Procter, M.Rouncefield and M.Sharpe (2000) Being there and doing IT in the workplace: a case study of a co-development approach in healthcare, Proceedings of the CPSR/IFIP WG 9.1 Participatory Design Conference, New York, 28 November–1 December: 96–105. Kaplan, B. (2001) Evaluating informatics applications: some alternative approaches: theory, social interactionism and call for methodological pluralism, International Journal of Medical Informatics 64:39–56. Latour, B. (1996) Aramis, or the Love of Technology. Cambridge: Harvard University Press. Massaro, T.A. (1993a) Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior, Academic Medicine 68: 20–5. Massaro, T.A. (1993b) Introducing physician order entry at a major academic medical center: II. Impact on medical education, Academic Medicine 68:25–30. McDonald, C.J., S.L.Hui, W.M.Tierney, S.J.Cohen, M.Weinberger and G.P.McCabe (1984) Reminders to physicians from an introspective computer medical record. A two-year randomized trial, Annals of Internal Medicine 100:130–8.
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Health Information Management In al
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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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Chapter 3 Health care work and pati
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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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Page 240 and 241: INDEX 225 satisfaction 176 patient
Page 242: INDEX 227 support 164 technology de
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