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WAITING FOR GODOT 17 (Lewinski-Corwin 1922) In a study of the problems of medical record keeping, the lack of motivation among physicians was mentioned as the main obstacle: In response to the question of what difficulties were met with, not one hospital mentioned any trouble in getting the clerical part of the work done. The difficulties all seemed to be in getting proper reports of the histories, physical examination, operations, etc…. All this, of course, with the exception of the shortage of house officers, points to a lack of interest and cooperation on the part of the doctors. (Stevens 1919) In order to be able to guarantee proficient record keeping, hospitals began to hire new, clerical staff: Of course the first thing that suggests itself is to have a competent stenographer who will take down dictations at the time of the visit and after the operations. This stenographer could also take care of the clerical part of the work and the details of the follow-up system. (Stevens 1919) In addition to stenographers, the professions of ‘record clerk’ and ‘record librarian’ were created. They were in charge of setting up and keeping up to date the central record systems. Generally, they had the right to call on medical staff who failed to complete forms and records properly: The record clerk peruses the chart from the first sheet to the last, making notations on the small pad (which is addressed to the intern) of any deficiencies noted on the chart…if there are any deficiencies on the chart, the red signal is replaced by a green signal…. When the intern has corrected the deficiencies on his record and has returned the slip to the record office the green signal is then removed from the card. This leaves a clear margin and indicates that the charts in a given area have been checked and are satisfactory in every detail. (Gilman 1932) In some cases, clerks took their monitoring task to considerable lengths: The record room clerk shall post each day on a bulletin board at the entrance of the hospital the number of incompetent histories opposite the name of the member of the staff responsible for their completion. (Auchincloss 1926)
18 STARTING POINTS Such reorganization was no longer just a matter of more staff. The primary location of records was replaced from the ward or the physician’s office to the ‘record room’. In addition to new technologies, such as dictating machines and pneumatic dispatch for transporting records, many architectural adjustments proved to be necessary as well. These were not always easy to realize: In older institutions, however, built before the days of hospital standardization or of emphasis upon hospital record-keeping, the installation of a record department has in many cases been a difficult problem…. The ideal record room is near enough to the operating room, laboratories, and staff room to make it convenient to access, yet sufficiently secluded to be a suitable place for quiet work, on the part of both the record room staff and the attending doctors, interns, and technicians who may come there to complete unfinished charts, for information, or for research. (Genevieve Morse 1934) The new hospitals were designed as centralized high-rise buildings, in part because this type of building reduces the transportation times of the steadily increasing number of forms, records, materials, and patients that were moved up and down between the various offices and wards: The distance covered in vertical transportation is shorter than that in horizontal transportation—even though in the former case one remains dependent on the proper functioning of elevators and the staff who service them. (Mansholt 1931) Another consequence of the vast increase in paperwork was the need to standardize medical terminology. Outpatient clinics and wards were to use the same ‘nomenclature of disease and nomenclature of operations’ (Genevieve Morse 1934), if at least the notes of one individual are to be comprehensible to another. The use of standardized terminology made it possible, for instance, to compare groups of patients with each other on the basis of the records: The cards in the diagnosis catalogue are arranged according to Dr. Post’s ‘Nomenclature of Diseases and Conditions,’ in which entries are grouped primarily under the different systems and secondarily under anatomical parts, in alphabetical order. Thus the cards referring to all the diseases of an anatomical part can be found at a glance. (Anonymous 1912)
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 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 78 and 79: THE CONTEXTUAL NATURE OF INFORMATIO
Page 80 and 81: THE CONTEXTUAL NATURE OF INFORMATIO
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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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