Health Information Management: Integrating Information Technology ...

14 STARTING POINTS
trained nursing staff had to be available. In addition, systematic patient-oriented
records, as opposed to ward records, had to be kept for all patients:
Accurate, accessible, and complete written records must be kept for all
patients and should include patient identification, complaints, personal and
family history, history of present illness, physical examination, record of
special examination such as consultations, clinical laboratory and x-ray
results, provisional or working diagnosis, proposed medical or surgical
therapy, gross and microscopic findings, progress notes, final diagnosis,
condition on discharge, follow up and in case of death autopsy findings.
(Atwater 1989)
Adequate, patient-oriented record keeping was one of the priorities of the
Hospital Standardization Movement, co-initiated by the College. Its concern for
standardization did not appear out of the blue. It was inspired by the
scientifically motivated methods of management that had become popular in
American industry and business. This approach favoured a ‘scientific’
organization of the production process, whereby complex tasks were divided into
standardized and clearly delineated subtasks in order to raise the efficiency and
controllability of the process as a whole. An accurate, centralized administration
was seen as an essential requirement:
The basis of this standardized service is to know what the hospital is
doing, and to record its work in such a way as to enable an appraisement to
be made of it…. Records, therefore, are a prime essential in any program
of hospital standardization…. Case records are the visible evidence of
what the hospital is accomplishing…. Not to maintain case records
properly is like running a factory without a record of the product.
(Huffman 1972)
Thus the need to keep records was not only triggered by the need for standards
of accreditation. An explicit function of records in industrial contexts involved
the monitoring of the activities of employees by the management. Even when the
employees were physicians, the management could benefit from having
control mechanisms at its disposal, as is illustrated by the following words of a
hospital board member:
The advantage of having a complete hospital record…, not a long one, but
a complete one, was illustrated to me…[The superintendent] had asked the
clerk to take the records of four men occupying similar positions on the
staff, the man in dispute being one of them, and bring him these men’s
records of operations for three months, the character of the operation, the
result, and the number of days the patient remained in the hospital, so that
when this man came to him and said he was being persecuted, he had definite