ABSTRACT
Successful design, implementation and utilization of information systems in health care starts with a thorough understanding of the practices in which the systems are planned to function. In the previous chapter, we discussed the nature of health care work and the role of paper-based and electronic information systems in that work. In this chapter, we will discuss the nature of health care information, to illuminate problems and potentials in the design and utilization of PCISs. In government reports on electronic patient records, and in much of the medical informatics literature, the PCIS is often seen to afford the utilization of data gathered in the care process for secondary purposes: administration, financial management, research and so forth. Since the information gathered by the nurses and doctors that are managing the patient’s trajectory would no longer be ‘imprisoned’ in the immutable paper pages of the traditional record, many additional users could draw upon this information. The Council on Scientific Affairs of the American Medical Association, for example, states that ‘users [of the record] can be grouped into seven categories: providers, patients, educators, researchers, payers, managers and reviewers, and licensing and accrediting agencies and professional associations’ (1993). All such users desire more detailed, more timely and more comprehensive information about the inner workings of health care-and all have high expectations about what the EPR could bring them.
