Health Information Management: Integrating Information Technology ...

32 STARTING POINTS
especially since the majority of initiatives was only marginally successful or
evaporated quite quickly. The Danish GP Association terminated its GP
information system project, which had become too costly to maintain. The early,
information collecting UK initiatives also died at the end of the 1980s. In both
cases, enthusiastic individuals (often GPs) took over these initial attempts, and,
as in the Netherlands, started to develop systems that were built by individuals
(or small companies) for individual GP practices.
In fact, the realization that the technical, social and organizational complexity
of EPRs in health care practices has been seriously underestimated is gaining
terrain. So far, EPRs have not ‘replaced’ paper records at all: both modes of
recording data exist side by side, and, not surprisingly, this situation has led to an
increase in the number of clerical tasks. The ever growing stack of printouts has
undoubtedly opened the eyes of those who not too long ago still dreamed of an
office environment not cluttered with piles of paperwork. The NHS Net is
cheered by the NHS Information Management authorities, but criticized by
others as being an ‘expensive way to get on the internet’ 2 that all too often
‘simply grinds to a halt’ (Majeed, 2003:690). It is riddled by privacy questions,
disputes about obligatory, costly usage, and the nagging question whether its
functionality would not have been realizable by drawing upon much cheaper,
common Internet technologies and infrastructures. ‘The first four decades of
medical informatics,’ as Collen soberly concludes, ‘were ones of high
expectations and frequent disappointments’ (1995).
At the beginning of the twenty-first century, the overall ‘penetration’ of IT in
health care organizations is considerable. Routinely, nurses and physicians
encounter PCs or terminals, read medical patient information using a clinical
workstation, or create discharge reports using voice-recognition software. With
regard to the GP information systems, the UK, Denmark and the Netherlands
are amongst the world’s leading health care ICT users. Yet their success—
informating individual practices—is now their largest problem: how to integrate
GP information systems in the larger health care information flows? The overall
situation is patchy and difficult to summarize. Hospital laboratories may have stateof-the-art
information systems, while the physicians requesting tests do so by
using traditional paper forms. These physicians might be able to query the digital
archives of their radiology department, but still receive the laboratories’ results
through ordinary mail. Effective coordination (between and within institutions,
between and within countries) is virtually absent: individual hospitals go about
their own ways, individual departments within hospitals go about their own ways,
and different providers go about their own ways. The result is called ‘island
automation’: departments have information systems which only cater to their
own needs, and these systems can hardly communicate with other systems (if at
all), while in between other departments are situated without terminals
altogether. Often, it is difficult or even impossible to integrate such
independently developed systems within a larger HIS system—let alone that