Health Information Management: Integrating Information Technology ...

HEALTH CARE WORK AND INFORMATION SYSTEMS 53
medical professionals they function more effectively than is generally assumed.
Even thick, substantial records create less problems when tracing specific
information because medical professionals have ‘effective strategies for
limitation of search space by perception of positional and textual features’
(Nygren and Henriksson 1992). Regarding these features, these authors argue, a
paper patient record is superior to a computer screen. Paper records contain many
informational ‘cues’, like coloured pages (which enhance fast tracking of
information), their size (which provides instant information on the length or
complexity of the patient trajectory), the various handwritings, the ink colours
and types of pencils, the post-it notes, underlinings, arrows, markings and so on.
The speed with which experienced medical professionals know how to zoom in
on relevant parts of the record is striking, Nygren and Henrisson suggest, and the
information quantity ‘covered by a glance is enormous’. A nurse from the
neurology ward of a regional hospital put it as follows:
PRACTITIONER’S PERSPECTIVE
With paper records you had a better overview, now you really have to go and
search the various windows. The care plan is conveniently arranged, but for
writing down notes things used to be better…. The night shift wrote in red, the
day shift in blue, and the evening shift in green. You would just open up a folder
and you could continue to write right away. On the left side, there was a nursing
problem and to the right the plan, so you could easily see what had changed and
what had been done…even if you had been gone for three days.
Such experiences are by no means exceptions. Some functionalities of paper
just cannot easily be matched: you can take paper records along easily, put them
next to you while interacting with a patient, or you quickly leaf through them and
make a brief note. Conversely, it is harder to type and look at the screen when
interacting with other medical professionals or patients, while the interactions
also tend be interrupted more.
More importantly, still, paper-based records deserve merit for constituting the
most widespread and successful information system in health care. They have
been around for at least a hundred years (see Chapter 2), and they have coevolved
and adapted to the changing contexts of Western medicine to a
surprising degree. Its functions are a sine qua non for the ongoing work in current
Western health care practices. The paper PCIS’s accumulating function makes it
possible for one health care centre to provide care to thousands of patients, each
of whom can be seen by dozens of professionals at different moments in time.
Only through some type of system that is (relatively) easy and uniformly
accessible, and that gathers all (or most of) the relevant information on a patient
is any remote sense of ‘continuous’ or ‘integrated’ care thinkable.
The coordination function is similarly pivotal for Western medical work. The
structured forms, check lists and protocols in the record afford highly complex