HCIS

Evolution of Health Care Information Systems



Evolution of Health Care Information Systems

Introduction

'Developing a comprehensive medical information system', Morris Collen concluded in his historical survey of medical informatics in 1995, appears “a more complex task than putting a man on the moon had been” (Wager, et al., 2005, p. 464). Although we hear much more about successes, certain benefits and the need to implement patient care information systems (PCIS) in health care, the fact is that most applications to date have failed. Large numbers of systems never make it off the drawing table—and if they do, they do not appear to be transportable out of the specific context in which they were developed. Although precise data are lacking, a general handbook on management information systems estimated that from the large systems that end up being used as much as 75% should be considered to be operating failures. They might be in operation, but they are too cumbersome, too expensive or too functionally deficient to be even remotely called a 'success'. And in a recent overview of clinical data systems, Jeremy Wyatt mentions a staggering figure of 98% of software built for US government use that was 'unusable as delivered' .

The sociotechnical approach: starting points

Some 20 years ago, the term 'sociotechnical system design' was used to indicate design approaches that stressed the importance of job satisfaction, workers' needs, and skill enhancement. These approaches put people and their working relationships center stage and formed a long-needed antidote to the technology-centered and top-down approaches that dominated system development(Skurka, 2003). In current times, the term has drifted from this direct focus on workers' emancipation. Embracing a user-oriented perspective, sociotechnical approaches emphasize that thorough insight into the work practices in which IT applications will be used should be the starting point for design and implementation.



The nature of health care work

The core activity of health care work practices is 'managing patients' trajectories': doing investigations, monitoring, intervening and re-intervening in order to at least temporarily cure or palliate patients' problems. In all but a few instances, managing patients' trajectories is a collective, cooperative enterprise(Wager, et al., 2005). Even the individually operating general practitioner communicates with his/her colleagues. A fundamental characteristic of this work is its pragmatic, fluid character. Like other complex work activities, it is characterized by the constant emergence of contingencies that require ad hoc and pragmatic responses.

Although much work follows routinized paths, the complexity of health care organizations and the never fully predictable nature of patients' reactions to interventions result in an ongoing stream of sudden events. These have to be dealt with on the spot, by whomever happens to be present, and with whatever resources happen to be at hand. In addition, and partly because of this phenomenon, health care work is typified by ongoing negotiations about the nature of the tasks and the relationships between those who execute the tasks(Skurka, 2003). The sociologist Hughes, for example, has documented how experienced nurses often help inexperienced residents by suggesting the way towards the diagnosis, or ...