This article is concerned with technology driven IT plans and visions in health care, and their interferences with medical practices and uses of information. Drawing on fieldwork from a study of the implementation of an electronic patient record in a hospital in Norway, it analyses different instances of information generation, use and sharing in order to consider the role of IT and electronic information flow in medical practice. When compared with practice, the model of information in IT plans turns out to be very narrow and rigid as to what should count as information; what the proper form of information is; and what paths it should take. The argument is that the implementation of IT built on this model of information first excludes large parts of the information practices and processes in medical work; secondly adds to the dependence upon other forms of information, and information flow and sharing; and third, creates extra work.
Keywords: Health care services, public IT programmes, electronic patient records, medical practice, information flow, fluid and collective information
Introduction: IT programmes in health care services
In Norway as in many other countries the future and modernisation of the public sector is at the top of the public and political agenda. There are strategy plans and programs to promote innovation and renewal in the public sector - as well as programs for research into these processes, their conditions and obstacles.1 In these public plans and programs, IT holds a position as a particularly promising and powerful means for improving public service delivery, quality and efficiency. And health care is one sector which is made the target of huge investments into IT.
In the most recent governmental strategy document on IT in health care services in Norway, Te@mwork 2007:Electronic Cooperation in the Health and Social Sector, it is put like this:
A comprehensive focus on the priority areas of information and computing technology (ICT) is regarded by many as the most effective measure for improving quality and effectiveness in the health and social sector. (4)
And then to support this claim, the strategy plan refers to the importance IT in healthcare is attributed internationally, and quotes an EU report which boldly states that
eHealth is the single-most important revolution in healthcare since the advent of modern medicines, vaccines, or even public health measures like sanitation and clean water.2
The reason for these visionary hopes in IT in health care services relates partly to problems and challenges identified internally to medical and health care practices, and partly to problems and challenges in their administration and management. In both cases, information flow - or, more correctly, the lack of information flow - is defined as a critical point and problem. Barriers to the desired development, it is said, lie in systems that don't speak the same language, and in meetings between paper based and electronic information systems. Accordingly, the national strategy plan identifies as the primary challenge and priority the strengthening of information flow by using IT, and, more ambitiously still, transition from the present situation characterized by heterogeneous and hybrid information systems and communication to all-electronic and uninterrupted information flow (S@mspill 2007, 12).
It is this idea of 'electronic flow', and the plans and visions for health care services it is embedded in, that I interrogate in this article. In the last few years 'electronic flow' has become a trope in IT policy not only in health care but in e-government discourses more generally. In this discourse, flow, and particularly flow made possible and generated by the networks of IT, is conceived as a decisive characteristic and most often also as a condition and driving force in the reshaping of organisations and social formations of our time. In its more rationalist and functionalist applications, IT and electronic flow is the means and tool which spurs an efficiency-enhancing reengineering of the organisation where everything that is 'superfluous' is cut away. …