Health Information Management: Integrating Information Technology ...

58 STARTING POINTS
effort on the part of the health care professionals who use it. They have to generate
the conditions under which the PCIS’s potential can be optimally exploited.
The computational powers of IT can change the coordination function of the
record in four ways:
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it can track events and send messages to trigger these, and so coordinate them
more powerfully (e.g. controlling whether a medication order has been
executed, for example);
it can sequence and structure activities more powerfully (e.g. by not letting a
professional proceed to a next step before a previous step is completed);
it can make synchronous coordination possible (the speed of electronic
communication makes possible the simultaneous coordination of activities (by
people and/or other artefacts) in different geographical sites (e.g. through a
multimedia connection));
it can facilitate coordination between more locations and/or more entities
(once an infrastructure is installed, all the above mentioned functions can be
distributed over larger numbers of recipients).
These more powerful coordinating functions of a PCIS can only properly
articulate with professionals’ activities if the latter become more strongly aligned
to the record’s demands. That is to say: more powerful functions require more
standardization of
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workprocesses (meticulously following the structuring of the PCIS and
keeping one’s electronic agenda in precise order);
data (agreement on terminology, coding and precise completion of records);
decision criteria (adequate synchronous coordination and reminder systems
require agreed upon decision criteria between system designers and
(distributed) users).
On all these levels, increased standardization is a sine qua non for the PCIS’s
coordinating activities to work.
RETURN TO THE PARADOX: INTERMEDIATE
CONCLUSION
The work of health care professionals centres on the management of patient
trajectories: the monitoring or redirecting of the course of a patient’s disease or
problem. This is a social, interactive process in which a wide array of interests
and concerns come to bear. Consequently, the actual form of a patient trajectory
is impossible to predict, as is true of the developmental trajectory of a PCIS itself
(cf. Chapter 2). Patient records fulfil two interdependent roles in this work: they
accumulate inscriptions and they coordinate activities. The PCIS may fulfil these
roles in a more active way. This implies, however, that health care professionals