Health Information Management: Integrating Information Technology ...

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assumption that the relationship between patient and physician is a long-term
one. As a result, these general physicians are more inclined to invest in systems
that make it easier to keep track of their patients than, for instance, their
American colleagues who work with much more fragmented populations of
patients. In the Danish case, however, government support arrived too late—the
Danish GP association already had let go of its EPR at the time the government
started pouring resources into health care IT development. As a consequence, at
the time that the Dutch GP information systems really took off throughout the
Dutch GP population, the Danish development slowed down substantially for
several years. Additionally, in the 1970s, Dutch general practice was strongly
aimed at prevention, and was founding its ‘scientific basis’ through a strong call
for population-oriented health care research—much like its UK counterparts.
Thus, the conditions of Dutch family medicine were such that the advantages of
the EPR—specifically the opportunities it offered for prevention and keeping
track of groups of patients—were immediately evident. Yet unlike the UK, these
systems were not primarily built for these purposes, which, undoubtedly,
prevented an early demise as in the UK. All in all, in short, ‘successful ICT
development’ is a more or less happy confluence of contingent developments and
interests, which is highly unpredictable.
The downfall of Dutch GPIS was an equally contingent affair. The dust on this
issue has not yet settled—many of the involved parties (GPIS user groups, vendors,
government, GP associations) are still shifting the blame. Yet it is clear that the
high functionality of the earlier systems had been developed over many years, in
close cooperation between academia, GPs and (often small and local) vendors.
When the underlying software technologies of these packages became too
outdated, and when the pressure to make these systems more inter-operable
became high, vendors realized that novel developments would entail a much
higher investment, given the existing, high expectations about functionality,
flexibility of use, interoperability, and so forth. Since neither government nor
insurance companies were willing to significantly rise the GPs’ fee for ICT
investments, vendors (who had often been bought up by larger, often non-Dutch
companies) cut their losses, and announced their withdrawal from this section of
the market. At this moment, parties are frantically searching for solutions: new
small vendors are trying to win a corner of the market, others are pleading for
Open Source solutions, 4 while others state that GPIS systems are obsolete.
According to them, the solution should be sought in integrated patient care
information systems, co-used by GP, specialist and other health care
professionals.
Health care IT, then, can be said to be thoroughly ‘social’ in three ways. First
of all, the development and implementation of such technologies are processes of
ongoing negotiations, involving many different stakeholders that fight for their
positions, and their views on how things should be organized. Second, because
the ‘final’ IT application is the outcome of these processes, it itself ‘reflects’ this
coming-into-being (German systems with German bureaucratic regimes built