Health Information Management: Integrating Information Technology ...

16 STARTING POINTS
Subpoena of the record enables any court to obtain a true statement
concerning the patient’s care and treatment in connection with insurance
claims, employees’ liability claims, suit for damages and malpractice.
(Munger 1928)
Obviously, it did not take long for this juridical function to become itself an
important incentive for a more complete, standardized recording of data on
patients.
Standardized recording of patient data may have been useful in many
contexts, but its realization proved no easy task. The Hospital Standardization
Movement had to convince hospitals, physicians, and patients of its significance,
and an infrastructure for the creation and storage of records had to be developed.
For one, physicians generally saw little use for keeping exhaustive records. In
their day-to-day performance, just a few catchwords, jotted down in a log or a
notebook, would do in most cases. On the whole, American physicians worked
very much on their own. They were associated to hospitals as private physicians,
responsible for following their ‘own’ patients on their therapeutic trajectory
during their stay in hospital. These patients tended to see few other physicians
and so a physician’s memory could suffice. Poor patients could not afford to
have their own physician. Their notes—if any—ended up in the ward record, the
brevity of which matched the brevity of attention such patients could be expected
to receive.
Although the methods of reporting data on patients would do in the eyes of
most physicians, the advocates of the Hospital Standardization Movement
deemed it absolutely unacceptable. Frequently, they claimed, physicians kept
notes and records in an ‘exceedingly laconic’ manner (Davis 1920):
The various diagnostic procedures are often neither dated nor signed…. The
bedside notes seldom give a complete picture of the case. There is likewise
hardly ever a note as to the condition of the patient at discharge.
(Lewinski-Corwin 1922)
In principle, the records on private patients were patient-oriented, but most
physicians kept them to themselves. A more ‘public’ storage of this
confidential information was considered a violation or even betrayal of the unique
relationship of trust between doctor and patient. In terms of their administrative
value and continuity, these private records could never fulfil the functions as
envisioned by the Hospital Standardization Movement. Thus, they equally failed
to meet the standards of accreditation as formulated by the College of Surgeons:
The private patient records are worse than the ward records. In some of the
hospitals, no records of the private patients are required for the central file,
thus making the relationship of the patient to the hospital purely that of a
hotel.