Health Information Management: Integrating Information Technology ...

36 STARTING POINTS
laboratory data—generated by lab computers—are directly taken out of HIS in
the ICU application. Put differently, the ‘digitalization’ of medical practices
itself contributes to their further automation.
technology. The developmental processes are too complex for identifying such
simple, causal lines. The need for a closer link between patient record and
hospital bill is one of the incentives for introducing the EPR—yet, conversely,
the link itself fosters the need. Once it becomes possible to link individual
patient data to financial data, the tendency to refine financial administrative
procedures will be difficult to counter. Similarly, the EPR does not simply
‘cause’ organizational change: it may stir up, hinder or deflect developments that
were already in motion, for example, or trigger a change process that will thereafter
interweave with many other ongoing developments. The changing professional
role of the general physician, the shifting power of the insurance company, the
changing job definitions of health care professionals, the role of the patient—all
those issues are bound up with the introduction and development of EPRs, yet
none is simply ‘determined’ by it.
The historical episodes discussed above also again illustrate the irregularity of
the trajectories in which technologies are being shaped as well as the unpredictable
interplay between the various driving forces involved. While Dutch general
physicians were one of the world leaders in the application of EPRs only five
years ago, for example, their systems’ vendors are now massively ending further
developments of these GPISs. In a small market, with highly demanding
customers (the GPs), and others arguing that separate GPISs had become
obsolete, newer generation GPISs seem simply too costly and risky to produce.
Similarly, the early UK emphasis on market research and disease management
has undoubtedly marked the subsequent development of newer UK GP
information systems—the demise of these first systems notwithstanding. Twenty
years later, UK GP information systems are strikingly different from their Danish
and Dutch counterparts in their emphasis on making quite detailed registration on
patients’ medical and social history and life style factors.
Undoubtedly, the Danish and Dutch professional organizations of general
physicians started out to tackle the issue in a strategic way. Both considered the
EPR as a tool to protect and enhance the professional position of the physician
(see also Chapter 4). Because of the well-designed GPIS, the Dutch general
physicians strengthened their role as a central organizational node of the health
care system, where patient data are gathered and stored—thus enabling their role
of patient record coordinator. Yet the physicians’ professional organizations
were just one actor in the overall network. The Dutch government—later on
followed by the insurance companies—decided to support GPIS because it
anticipated that automated data processing would also benefit its own
information needs. Moreover, an important explanation of the early success of
GPISs is the Dutch and Danish ‘gatekeeper’ system that operates on the