Health Information Management: Integrating Information Technology ...

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different HIS systems can talk to each other or to GP information systems, for
example.
This situation becomes even more complicated because many hospitals are
still dependent on HIS systems which date from the early 1980s. Such so-called
‘legacy systems’ are typified by poor user-interfaces, are monolithic and hard or
impossible to couple to other information systems, and are increasingly difficult
to maintain. On the other hand, they have developed over long time-periods,
have become an integrated part of an organization’s functioning, and are very
expensive to replace. In many situations, thus, more or less improvisatory
connections are made to link legacy systems to more modern, state of the art
modules that add to or take over part of the functions of the legacy system
(ibid.). In this way, many Electronic Patient Records are now evolving: as a thin,
graphic-oriented layer that looks very modern, but in fact lies on top of (a)
decades old information system(s).
In 1997, the Institute of Medicine published an update of their report, stating
that progress has not been all that successful. Health care organizations have
invested less than they could have; governments have failed to take action on
eliminating legal obstacles (such as the requirement to keep a ‘paper archive’, or
to have signatures ‘in ink’) or to supply the necessary funding, and the lack of
standards hinders further development. The developments between countries are
hardly converging: due to the differences between health care systems, the
prevalence of locally developed legacy systems and the local ties of vendors, a
‘global’ EPR market is virtually non-existent.
In addition, many health care ICT development and implementation projects
still fail. Health ICT constantly seems to promise more than it can deliver. EPRs
are promised but not delivered, vendors discontinue support for existing systems,
or implementation projects run to the ground. In France, the 1999 opening of the
‘hospital of the future’, Hôpital Européen George Pompidou in Paris, turned into
a nightmare when the ‘paperless environment’ failed to function. The robots in
the operating theatres appeared too complicated to use, the EPR was impossible
to use, and critics calculated that trying to order medications through the system
was 1,000 per cent slower than with the ordinary, paper-based systems.
Overnight, paper-based records had to be printed and put into use, although the
hospital had proudly been built without any archive space or other logistical
support for paper records. In the Netherlands, meanwhile, millions of Euros were
spent on developing a ‘health card’, using chipcard technology, which would
provide an infrastructure for administrative (insurance) data, and develop further
into a basic health care information carrier. After years of promises,
technological problems and political fights about who would pay what, and who
would do what for who, the project was declared ‘dead’ in 2002. Similarly, the
UK has its infamous failure cases, such as the Wessex Health Authority
Regional Information System, cancelled in 1990 after spending more than £20
million, and the national Hospital Information System projects, started in the
1980s that cost over £32 million and have yielded only minimal results. When