Abstract
Health care applications are technically complex and the software and hardware markets for medical technologies are less mature than for many other fields. Although there should be an interplay between design and the usage of systems, this is often not the case in the health care sector. Currently, information is often bound to a location or institution due to fragmented information systems. Using the notion of asset specificity as a theoretical background, the authors conducted interviews in the Finnish primary health care system. The interviews were analyzed and examples of real life situations are provided to guide designers of information systems for the health care sector.
TopIntroduction
Information systems in health care have been proven to have several benefits, such as the improved quality of care and the accessibility of information (Åkersson, Saveman & Nilsson, 2007), or improved financial outcomes (Menachemi, Burkhardt, Shewchuk, Burke & Brooks, 2006) However, despite the possible advantages, the use of IT in health care lags behind other industries (Menon, Lee & Eldenburg, 2000) and there is evidence that information systems might even have negative effects on a health care organizations’ performance (e.g. Hsieh, Kuperman, Jaggi, Hojnowski-Diaz, Fiskio, Williams, Bates & Gandhi, 2004; Nebeker, Hoffman, Weir, Bennett & Hurdle, 2005)
The reasons for the disadvantages are many, besides the technical challenges, the introduction of IT is considered to have major impact at a cultural and social level (Bashshur, Reardon & Shannon, 2001). Another challenge is the diversity of stakeholders that are involved in IT implementation projects and their different roles in a complex health care setting (Pouloudi, 1999). Furthermore, as Chiasson and Davidson (2004) state, health care applications are technically complex and the software and hardware markets for medical technologies are less mature than for many other fields. Although there should be an interplay between the design and usage of a system, this is far too often not the case in the health care sector. Large national and international software companies design the systems and health care units have little chance of getting their requirements through without investing extensive sums of money.
In Finland, electronic health records (EHR) are already widely in use in primary care organizations. However, there are several different information systems in different health care organizations (Mäkelä, 2006) and interplay between these EHR’s is not possible. In order to efficiently and, foremost, safely treat the patients all the patient information should be available, regardless of the organization a patient at that point is being treated in.
One of the most crucial pieces of information about a patient in the health care system is his/her medication information. By medication information we refer in our paper to the generic and commercial name of the drug, the dosage and the use indication. For instance, in the U.S between 44,000 and 98,000 deaths are estimated to have occurred as a consequence of medical errors. A significant number of them are related to medication errors. (Anderson, Ramanujam, Hensel, Anderson & Sirio, 2006) A medication error can occur when the medication itself, the doses or the way it is taken are incorrect. Besides the actual errors, there are also cases when the medication has been given properly but it has caused, for instance, an allergic reaction in the patient. To prevent the errors caused by the medication up-to-date information about a patient’s current medication regimen is crucial.
The problems in managing medication information have been noticed by Finnish authorities and clinicians. To find out solutions, many projects have been started. This paper is part of one of those projects and the aim of the project is to model and explore how medication information is currently managed and what the main problems and bottlenecks are in managing it. The goal would be to have a system that facilitates the availability of the medication information so that it would be freely available to all stakeholders when needed. The purpose here is not to describe technical solutions (e.g. new information systems), rather it is to take a participatory socio-technical approach to analysing the problem. This, obviously, is an extremely complex task requiring that multiple organizations, professional groups and other stakeholders join in the process.
Key Terms in this Chapter
Human Specificity: Related to special knowledge that could be, for instance, job-specific and has developed along with the worker’s career. Therefore a professional working for a company etc. is valuable and if he/she decides to leave, costs could be caused by replacing their tacit knowledge. Also moving a person physically from one place to another is costly.
Time Specificity: An asset is time specific when the acquiring and using, or timing and coordination of activities related to it are critical and the time span for those activities is limited.
Medication Information: Refers to the patient specific medication regimen, e.g. knowledge on the generic and commercial name of the drug, the dosage and the use indication.
Knowledge Specificity: Has some of the same elements as human specificity but refers to the specific knowledge possessed by a very limited number of individuals, e.g. physicians. Transferring that knowledge from one person to another causes costs.
Asset Specificity: Relates to transaction cost theory (TCT) as developed by Williamson etc., and more specifically, to the specificity of the assets. Assets have a certain value and therefore moving them from one place to another might cause transaction costs. The different forms of specificities defined in the literature are for instance human specificity, physical specificity, site specificity and dedicated assets. Asset specificity is mainly related to commercial activity but could be also seen in other settings where there are other valued things involved, e.g. patient safety.
Site Specificity: An asset is site specific if moving it from one place to another is highly difficult or even impossible to move.
Primary Care: Usually the first level of health care services a patient meets in universal health care settings. Such care is provided by a health care professional, a nurse or physician (often a general practitioner). A variety of illnesses are taken care of in a primary care health center and a patient might have also different types of control visits there. Patients are referred to specialized hospital care from primary care, if required.