Health Information Management: Integrating Information Technology ...

HEALTH CARE WORK AND INFORMATION SYSTEMS 45
when the core worktasks are structured and interconnected in highly standardized
ways. Boeing’s engineers worked on clearly delineated subparts, following strict
requirements and strictly delineated methodologies. The work of doctors and
nurses, on the other hand, happens to be the organizational sociologists’
prototypical example of the work of a professional that is too complex and
variable to be standardized in this way. On the medical workfloor, the
coordination of their work is achieved, first of all, through constant supervision
and communication. In addition, every professional (say a nurse) knows what
(not) to expect from another professional (say a surgeon), since their
professional training equips them with standard sets of skills. IT can support
skills somewhat through decision support, and the cooperation between
professionals can be enhanced through IT communication tools. Yet, Groth
predicts, IT cannot do much to transform medicine’s core business. ‘Handling
patients’ is too much of an interpersonal and essentially non-standard activity to
become truly ‘informated’. High aims for patient care information systems,
therefore, are doomed to fail.
Such arguments about the limited potential of IT to transform health care work
do not stand alone. Many authors have pointed at the phenomenon that health
care work, what we will describe as the collaborative managing of patient
trajectories, is essentially interpretative, interactional, and typified by the need to
constantly react to contingent events. Medicine’s object (a patient, his/her history
and his/her affliction(s)), organizational conditions (many health care professions
with different backgrounds handling patients while time and resources are
scarce) and knowledge-base (rapidly developing, vastly expanding, but also
patchy, sometimes internally contradictory) together make ‘health care work’
into an enterprise whose complexity will remain elusive to strict protocollization,
detailed pre-planning or tight workflow approaches.
Does this mean, then, that there is not much future for integrated,
processoriented PCIS? Does this mean that we can make guidelines or modest
decision support tools (that both merely ‘suggest’ the proper action path to the
professional), or that we may optimize communications through telemedicine
applications—but that we cannot draw upon IT’s coordination powers to further
integrated care? Or to integrate quality management in the primary care process?
If that would be the case, this book could have been short indeed. In the
following three chapters, we will show how such pessimistic conclusions are not
necessary. First, however, we will address the specific nature of health care work:
a thorough understanding of this work is crucial to be able to develop systems
that may actually support it. Subsequently, we will briefly look at the operation
of a current core ‘information technology’ in medicine: the paper-based medical
record. This tool, including all the little forms and paper slips that are generated
through it and end up in it, currently facilitates order-communication, medication
management, and the integration of the activities of individual care
professionals. Although obviously far from perfect, this paper-based PCIS is a
proper starting point. Its long history and ubiquitous presence indicate that its