Health Information Management: Integrating Information Technology ...

THE CONTEXTUAL NATURE OF INFORMATION 75
information than three lines of preprinted, checked off standard formulations.
The way in which a medical problem is described generates a wealth of
information for the experienced medical professional. What is emphasized in the
free text? What is qualified in a subordinate clause? What is omitted? To what
extent does a formulation depart from standard narratives? This is no mysticism
or computer phobia, but a reflection of the fact that making data transferable
requires different demands—and at times even opposite demands—than the
efficient use of data in their immediate context of origin. Ideally, in the latter
case, data are rich in specific detail, low on information that users already know,
and tied to each other in a narrative sequence. By contrast, the perfect
transferable data are coded, independent from each other, and ridden of any
‘couleur locale’.
The accumulating function of PCIS, we conclude, has definitely acquired a
new dimension since the arrival of information technology. More active
accumulation creates entirely new options for using patient records, but making
information more cumulative requires more work as well. If medical data seem
to have universal qualities, then this is the result of much effort and not a natural,
intrinsic quality of these data. As soon as data are accumulated so as to make
them more accessible to third parties it is important to start asking critical
questions. Adding this new task to the workload of health care professionals who
tend to be overburdened already will doubtlessly take away more of their time—
precious time which might be spent on other tasks, such as the care for the patient.
CONCLUSION
In this chapter we discussed the contextual nature of health care information.
Health care information should not be conceived as some sort of substance or raw
material that can be ‘harvested’ and ‘transported’ freely at the risk of privacy
concerns only. Rather, information is always tied to the context of its production:
inscriptions only become ‘information’ if they are placed in a specific context.
At the same time, records accumulate information, we already argued in the
previous chapter. This implies not just a passive ‘collecting’ of inscriptions: it
implies actively adding structure to the data inscribed in it. If the paper record
would just gather the information without smartly organizing and integrating it
in meaningful wholes, the information would again be impossible to retrieve and
assimilate in the short and dispersed spans of time that typify most professionals’
working days.
Paper records, it seems, have probably been criticized all too harshly within
medical informatics. In the previous chapter, we already pointed out that health
care professionals get much more out of paper records much faster than most
critics would assume. Also, paper has use-features—easy to handle, easy to
annotate, high information load per cm 2 — that are still hard to beat with
electronic means. In this chapter, we encountered even more arguments why
much of today’s criticism on paper record keeping is at least too simplistic. The