Health Information Management: Integrating Information Technology ...

THE CONTEXTUAL NATURE OF INFORMATION 67
staging leukaemia. In this situation, this was a very efficient way of
communicating between each other—clear to everyone involved. In a different
clinical situation, this information might have meant something completely
different. If the patient would have been older, and suffering from another
chronic leukaemia, ‘Spleen—’ might have been taken to indicate that the
physician had confirmed that the spleen had been surgically removed. Or, in the
context of a patient who had been suffering from swollen axillar nodes, ‘Nodes—’
would indicate that the physician had looked at these nodes and found that the
swelling had disappeared.
The mutual elaboration of medical data also evolves over time: the temporal
dimension is as crucial to medical information as it is to a story. In the course of
a patient’s illness trajectory, data items are constantly reinterpreted and
reconstructed. Consider the following sequence of blood pressure measurements
in the post-operative patient mentioned above: at 6 a.m., 120/70; at 9 a.m., 125/
75; at 11 a.m., 115/65. If all other clinical signs would remain unchanged, then
this series of readings would most likely be read as a ‘stable blood pressure’. But
if the 1 p.m. reading would be 100/50, then the 11 p.m. reading would be
reinterpreted as the beginning of the decline. At many medical wards, medical
work is characterized by this ongoing (re)interpretation of the tendencies in
graphs and tables: is this temperature going up? Is this haemoglobin level stable?
Again, medical information is not a timeless collection of unchangeable entities,
that retain their essence once captured in a record.
So far, then, we have seen two ways in which medical information is
entangled with the context of its production: medical data are tied to the purpose
of their generation and they are part of an evolving array of medical data which
continually reshapes their meanings. The two are closely related: doctors are
aware of the constantly evolving nature of the data they produce, and they
generate their data accordingly. When Agnes checked upon this patient the next
day, she did not change the entry for the blood pressure she had entered the day
before (‘135/70’), although the monitor now read ‘125/65’. For all practical
purposes, and in this particular, stable patient, this was not a difference worthy of
registration. Agnes does not intend the ‘S1 S2’ and ‘none’ entries to stand for an
in-depth scrutiny of this patient at that particular time. Rather, those marks are
intended to convey an ongoing monitoring process, in which, at this particular
moment, nothing noteworthy has changed or is expected to change within the
next monitoring episode.
The third way in which medical information is inextricably context-bound is
that ‘physicians [and other health workers] typically asses the adequacy of
medical information on the basis of the perceived credibility of the source’
(Cicourel 1990). That is: whenever a physician takes a specific piece of
information into account, s/he will assess that information in the light of who or
what generated it. When the supervising senior physician at the ICU encountered
Agnes’s progress notes during his rounds later the same day, he just nodded and
moved to the next patient. Agnes is an experienced resident, who has been