Health Information Management: Integrating Information Technology ...

STARTING POINTS 81
‘gender, race, age, ethnicity, income, education, disability, sexual
orientation, or location of residence’).
In an unusually critical tone, the Committee charges that the current US health
care system fails miserably on all these levels. It is highly fragmented, ‘a
nightmare to navigate’, ‘bewildering’ and ‘wasteful’. Any journey through it
includes many ‘steps and handoffs that slow down the care process and decrease
rather than improve safety’. All in all, ‘our attempts to deliver today’s
technologies with today’s medical production capabilities are the medical
equivalent of manufacturing microprocessors in a vacuum tube factory’ (2001,
28–30).
This already rather damning conclusion is further aggravated by the fact that
the demands on the health care system will increase substantially over the
coming years. Technological and scientific developments in fields such as
genomics will not slow down, the Committee argues, and this will significantly
add to the complexity of health care delivery. In addition, the incidence of
chronic conditions increases rapidly with the rise in life expectancy and
medicine’s increasing ability to ‘control’ diseases even if it cannot ‘cure’ them.
Meeting this challenge demands a readiness to think in radically new ways
about how to deliver health care services and how to assess and improve their
quality. Our present efforts resemble a team of engineers trying to break
the sound barrier by tinkering with a Model T Ford.
(Chassin et al. (1998) quoted in Committee on Quality of Health Care in
America (2000) pp. 23–4)
It is generally acknowledged by quality advocates that the Committee’s overall
insights are applicable to most Western countries. The issue of ‘equity’ might be
less significant for other countries, where lack of health insurance is not such a
major issue as in the United States. On the other hand, when increasing numbers
of patients pay high fees to private clinics to ‘bypass’ waiting lists in the UK or
the Netherlands, ‘equity’ is at stake there as well.
According to the Committee, information technology is a sine qua non for
Western health care to make the required quality leap. Information technology
can help prevent errors, and help link together currently fragmented care delivery
systems. It can truly transform Western health care practices—to make the jump
from ‘tinkering with a Model T Ford’ to ‘breaking the sound barrier’. This
statement, however, seems to be at odds with the paradox that we described in
Chapter 3 and 4: the more powerful the desired PCIS functionalities, the more
standardization (of work processes, data and decision criteria) is required.
Against the Committee’s high hopes, critics would argue that the possibilities of
ICT in professional work are fundamentally limited. The increased
standardization requirements, after all, will soon start to be counterproductive for
the quality of these professionals’ work.