Health Information Management: Integrating Information Technology ...

64 STARTING POINTS
information is always entangled with the context of its production. We will
discuss the implications of this rephrasing of the notion of ‘information’ for the
PCIS, and argue that the disentangling of information from its production
context is possible, but that it entails work. We will argue for the following ‘law
of medical information’: the further information has to be able to circulate (i.e.
the more different contexts it has to be usable in) the more work is required to
disentangle the information from the context of its production. The question that
then becomes pertinent is who has to do this work, and who reaps the benefits.
THE CONTEXTUAL NATURE OF INFORMATION
CASE STUDY
University Hospital, ICU, Thursday 9:05 a.m.
Agnes is still standing by the bed of the newly admitted patient.
The paper record from the operating theatre’s anaesthesiologist lies
next to the terminal of the ICU’s PCIS. This system, for both nurses
and physicians, has almost completely replaced the paper record.
(The system is a commercial product from a US-based firm,
specifically tailored to this ICU by two specially trained nurses and
an anaesthesiologist.) The nurses have already copied the relevant
medication from this list into their ‘worklist’ (one of the PCIS’s
‘forms’). Agnes looks at the PCIS’s worklist, and subsequently looks
at the ‘intensive care list’. This is a form designed as a spreadsheet,
covering one day, listing temperature, blood pressure and pulse
graphs, and rows with respiration parameters, medication, fluid
intake and loss, and so forth. These are all on the same page, in the
same temporal format, so that interrelated changes are rendered
visible. Some of these data are gathered automatically, but have to be
validated by a nurse (such as temperature and blood pressure); some
of these data have to be manually entered by the nurse (such as the
different forms of fluid loss). Agnes then opens the ‘progress notes’
(a pre-structured form where the relevant clinical information is
gathered). This form consists of sections such as ‘cardiac’,
‘pulmonary’, ‘abdomen’, ‘extremities’ which are subsequently split
up in separate fields as depicted in Figure 4.1. The fields show the
most recent entries made; each new entry erases the previous one
from the screen (without erasing it from the computer’s memory).
Figure 4.1 also shows the section ‘cardiac’ as Agnes encountered it.
Having listened to the heart and the lungs, she clicks at the cardiac
section, reads the blood pressure monitor, and types ‘135/70’ in the
field Tension. She types ‘S1 S2’ in the field Rhythm and ‘none’ in
the field Murmurs, leaving the rest of this section empty. The section
‘extremities’ remains empty/and in the section ‘pulmonary’ she only