Trust and Clinical Information Systems

Trust and Clinical Information Systems

Rania Shibl (University of the Sunshine Coast, Australia), Kay Fielden (UNITEC New Zealand, New Zealand), Andy Bissett (Sheffield Hallam University, UK) and Den Pain (Massey University, New Zealand)
DOI: 10.4018/978-1-60960-561-2.ch706

Abstract

Our study of the use of clinical decision support systems by general practitioners in New Zealand reveals the pervasive nature of the issue of trust. “Trust” was a term that spontaneously arose in interviews with end users, technical support personnel, and system suppliers. Technical definitions of reliability are discussed in our chapter, but the very human dimension of trust seems at least as significant, and we examine what is bound up in this concept. The various parties adopted different means of handling the trust question, and we explain these. Some paradoxical aspects emerge in the context of modern information systems, both with the question of trust and with the provision of technical or organisational solutions in response to the existence of trust. We conclude by considering what lessons may be drawn, both in terms of the nature of trust and what this might mean in the context of information systems.
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The Nature Of Trust

If, as Bottery (2000) says, “Trust is the cement of human relationships” (p. 71), then we may expect it to feature in the worlds of business and technology as much as in individual relationships. Fukuyama (1996) advances an extensive argument relating the flourishing of business and macro-economic success to the societal prevalence of stable, predictable, trustworthy dealings possible between individual and organisational actors. Echoing this, Bottery remarks how the absence of trust tends to result in, amongst other things: “detailed accountability, exhaustive legal agreements, and extensive litigation … it can mean vastly increased transaction costs, which can have important implications for the efficient use of time and money” (p. 72). O’Neill (2002) takes up these themes of accountability and litigation to develop a broadly Kantian perspective on trust. She argues that, whilst suspicion and mistrust appear to be increasing in the developed world, the world of the “audit society” (Power, 1997), nonetheless “We constantly place trust in others, in members of professions and in institutions” (O’Neill, 2002, p. 11). Often we have no ultimate guarantee, and at some point, we have to trust in a chain of information and the judgement that it informs: “Guarantees are useless unless they lead to a trusted source, and a regress of guarantees is no better for being longer unless it ends in a trusted source” (p. 6). O’Neill goes on to note the paradoxical circumstance that the proliferation of sources in the “information society” not only does not make trust redundant; it makes it if anything more problematical. Who should we trust in this world of instantaneous and burgeoning communication? How can we make informed judgements in a world of “information overload” and, sometimes, deliberate misinformation?

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