Health Information Management: Integrating Information Technology ...

44 STARTING POINTS
INTRODUCTION
In one of his classical works, the organizational sociologist Henry Mintzberg has
argued that the coordination of worktasks is a fundamental necessity for an
organization (1979). The activities of the individual(s) managing the
organization’s resources, to mention a simple example, have to be coordinated
with the activities of the individual(s) using those resources. A very small
organization can survive on mere ‘coordination by feedback’: the direct
coordination of work through direct supervision or informal communication
between the (few) employees. Larger organizations draw upon standardization
and technologies to tackle their increased coordination needs. When worktasks
are explicated and standardized, for example, the necessary coordination is
‘programmed’ into these specifications, and is then subsequently automatically
ensured. Likewise, the invention of the ‘record’, the filing cabinet and crossreferencing
and indexing systems made it possible for an increasingly complex
organization to handle an increasing number of clients. Such records are highly
efficient ‘externalized’ memories—making the continuous handling of one
individual by many different organizational members possible without the need
for constant face-to-face contact between those members.
Following Mintzberg, Lars Groth has argued that the revolutionary impact of
IT is that it enables new coordination mechanisms, and thereby makes new forms
of organization possible. As an example, he discusses the design of the Boeing
777: the first aeroplane that was fully designed using an integrated CAD/CAE
(computer aided design/engineering) system. This software did away with much
of the traditional model- and mock-up building: it could display each designed
part as a 3D picture, and would automatically detect whether any two planned
parts would occupy the same point in space. More significantly, it made it possible
for several thousand engineers (in different geographical locations) to
collaboratively work on one project ‘in real time’. An integrated database
connected all their workstations, so that each engineer could monitor and check
upon the work on parts and requirements that would affect his own work (1999,
pp. 310–12).
There would seem to be a great need for IT’s enhanced coordination capacities
in health care. The move towards integrated care, in which care processes are
redesigned around patients’ needs, breaking through traditional boundaries
between professionals, professions and institutions, would seem to be much
helped by even a fraction of the coordinating power that Boeing’s IT unleashed.
As we discussed in the previous chapter, the current development of PCIS aims
to structure and support the ‘core business process’ of health care: the primary
care process. Integrating patient record systems with order-entry, integral
medication management, inter-disciplinary carepaths and quality control
functionalities are all seen to be the way of the future.
Yet at this point, analysts such as Mintzberg and Groth have a great
disappointment in store. IT can only bring true organizational transformation