Health Information Management: Integrating Information Technology ...

THE CONTEXTUAL NATURE OF INFORMATION 63
KEY TERMS
■
■
■
Contextual nature of health care information
Primary and secondary purposes of data
Accumulation of data
INTRODUCTION
Successful design, implementation and utilization of information systems in
health care starts with a thorough understanding of the practices in which the
systems are planned to function. In the previous chapter, we discussed the nature
of health care work and the role of paper-based and electronic information
systems in that work. In this chapter, we will discuss the nature of health care
information, to illuminate problems and potentials in the design and utilization of
PCISs. In government reports on electronic patient records, and in much of the
medical informatics literature, the PCIS is often seen to afford the utilization of
data gathered in the care process for secondary purposes: administration,
financial management, research and so forth. Since the information gathered by
the nurses and doctors that are managing the patient’s trajectory would no longer
be ‘imprisoned’ in the immutable paper pages of the traditional record, many
additional users could draw upon this information. The Council on Scientific
Affairs of the American Medical Association, for example, states that ‘users [of
the record] can be grouped into seven categories: providers, patients, educators,
researchers, payers, managers and reviewers, and licensing and accrediting
agencies and professional associations’ (1993). All such users desire more
detailed, more timely and more comprehensive information about the inner
workings of health care—and all have high expectations about what the EPR could
bring them.
The secondary utilization of information has achieved much attention since it
touches upon the privacy of patients and the accountability of health care
professionals. The first point will not be discussed here; we will come back to
this issue of accountability in Chapter 5. Much less attention has been paid to
another issue: is the secondary utilization of health care data possible, and what
does it take to make it possible? In the views of much of the literature and
reports on health care information systems, this secondary utilization becomes
feasible as soon as the information technology (IT) connections are in place: it is
simply a matter of selecting which information to transport to where. In such a
view, medical information is conceptualized as the ‘givens’ about a patient that are
‘collected’ and then ‘stored’ in the record. Similar to much discussion about
‘information super-highways’ in general, ‘information’ is depicted as a
commodity: a substance that is present in the world, that is transferable, and
independent of its vehicle. It consists of autonomous, atom-like building blocks,
which can be stored in a neutral medium. In this chapter, we will argue that this
‘commodity’ view of medical information is fundamentally mistaken. Rather,