Health Information Management: Integrating Information Technology ...

THE CONTEXTUAL NATURE OF INFORMATION 73
that earnings threatened to go down drastically—which is why the idea of an
automatic link was quickly abandoned.
This does not mean that the utilization of health care information for research,
for generating bills or alarms is impossible. Far from it: the disentangling of
information from their primary care contexts, the making ‘mobile’ of data, is a
core component of health care work. What starts as an utterance understandable
only within the direct context of its production, has to be made ‘transportable’:
understandable elsewhere, and recognizable outside of the specific conditions of
its generation. This disentangling, however, is work. The fluid balance totals will
have to be adjusted, and details will have to be added or explained so that the
information becomes useable in the new context of use.
This is a crucial point: work is required to make data suitable for accumulation.
We might phrase this as a second ‘law of medical information’: the more active
the accumulation will be, the more work needs to be invested. Information
technology can help in this work: it can facilitate coding, for example, or
automatically code free text. Yet this can only facilitate the required work—it
cannot obviate its necessity. In order to create data that can be added, subtracted
and treated as ‘equals’ by the ICU PCIS, then, nurses have to follow meticulous
routines in data gathering and validation. If one would have wanted to use the fluid
balance totals for additional calculations, or if one would have wanted to
compare patients or draw upon these totals in other contexts, the transpiration
and respiration factor would have to be dealt with in a systematic fashion. This
would necessitate an additional investment: installing additional equipment to
measure respiration and transpiration, or manual corrections on every total by
experienced nurses or doctors. Similarly, if one wanted to compare total numbers
of patients requiring an influenza vaccination per region, for example, general
practitioners and assistants alike would have to meticulously keep and maintain
the codes.
Just like work processes need to become more standardized to make PCISs
work, then, health care information needs to become more standardized for the
additional accumulation powers of PCIS to come true. The level of
standardization achieved by the pre-structured forms and fields in today’s paper
medical records is generally insufficient for these aims. The entries that
professionals make in these records are mostly made for the purpose of the
proper unfolding of the primary care process. The notes and orders are meant to
be read and understood by colleagues and other ‘insiders’. For these purposes,
communicating in shorthand, omitting issues that are ‘self-evident’, and dwelling
upon local dialects is the rule rather than the exception. The need to be
meticulous, elaborate, to code data entered or to use even more pre-structured
forms is a demand that is inevitable when electronic PCISs are developed—but
that should not be taken lightly.
A central issue is the question where this additional work is to be done, and
where the benefits end up. In the case of the fluid balance, the nurses have to
invest time and effort in additional, meticulous routines. Yet they themselves are