Health Information Management: Integrating Information Technology ...

WAITING FOR GODOT 31
performance indicators has been initiated and the authorities hope that this
will enable better use of the registered data.
The arrival of microcomputers also created the technical possibility to develop GP
information systems. In the Case Study, we outlined the different trajectories that
this development took in three European countries: the UK, Denmark, and the
Netherlands. Especially in the early years, these developments were entirely
local: in each of these countries, enthusiastic professionals started experimenting
with the possibilities of computers for their worktasks. Accordingly, the different
systems took off in completely different directions. UK systems focused
primarily on aggregated data collection for clinical databases, and Dutch and
Danish systems focused primarily on reducing administrative work load for the
individual GPs. On the other hand, throughout the 1980s, the UK and Dutch
systems were run by entrepreneuring GPs or small businesses, while in Denmark
the national GP association coordinated this work until the downfall of its Apex
system.
The 1990s saw a veritable explosion of new initiatives involving EPRs. In the
United States, the Institute of Medicine published an influential report in 1991,
The Computer-Based Patient Record: An Essential Technology for Health Care,
in which it was argued that the EPR, as the cornerstone of a national health care
information system, was going to be the crucial technology in health care in the
years to come (Dick and Steen 1991). The report outlines a decade-long
offensive: by the year 2000, ‘the’ EPR had to be generally accepted. In Europe
the number of EPR initiatives was equally growing rapidly, in part as a result of
major funding from a number of large-scale European Research and
Development Programmes. At this point, some even metaphorically refer to the
presence of a ‘make 1,000 flowers bloom’ mentality: countless local projects
were funded with resounding names like HELIOS, GALEN and NUCLEUS.
Similarly, many countries started national initiatives. In France and Germany,
much effort was put into introducing ‘health smartcards’, facilitating the
handling of medical claims (between patient, provider and payer) and,
potentially, as a carrier for basic clinical information. In Norway, the five main
hospitals cooperated, and obtained government funds to further the development
of a common, integrated hospital information system, based upon an EPR.
The UK NHS put Information Management high on their agenda, and now
started to stress the importance of optimizing information flows for the prime
benefits of professionals and their patients. A core development in the 1990s was
the NHS Net, which would be the ‘NHS information highway’ through which
GPs, hospitals and community services could ‘share information’ and thus offer
‘genuinely seamless care for patients’. 1 This ‘NHS Net’ is a separate, ‘safe’
electronic highway for health care providers; a feature only dreamed of in many
other countries without centralized health ICT decision making.
Despite the explosion of initiatives, however, as the 1990s wore on, it was
widely believed that Dick and Steen’s estimation of ten years was too optimistic,