Academic journal article Journal of the Association for Information Systems

On Quality and Communication: The Relevance of Critical Theory to Health Informatics

Academic journal article Journal of the Association for Information Systems

On Quality and Communication: The Relevance of Critical Theory to Health Informatics

Article excerpt


Health information systems require long-term investment before they provide a socio-economic return, yet their implementation remains problematic, possibly because the claims made about them appear not to sit well with healthcare professionals' practice. Health informatics should address these issues from a sound conceptual base, such as might be provided by critical theory, which seeks to identify hidden assumptions and ideologies. This discipline can provide a better understanding of the inner workings of socio-technical systems, with a view to improving them through the promotion of emancipation (allowing people to fulfill their potential). Critical theory can also shed light on the problems with health information systems and offer insight into remedies, for example, by relating Habermas' theories about communication to feedback, a concept central to quality assurance (QA). Such analysis finds that QA's principal practices can be interpreted as emancipatory but requires organizations to substantially change their behavior. An alternate approach is to install health information systems designed to support QA. Applying critical theory to these systems shows that they could become an active part of service delivery rather than static repositories of data, because they may encourage standardized conversations between all stakeholders about the important features of health care. Success will depend on access for all participants to data entry and analysis tools, integration with work practice, and use by staff and management in QA. These ideas offer new directions for research into and the development of health information systems. The next step will be to implement them and observe their technical and emancipatory properties.

Keywords: Critical Theory, Habermas, Emancipation, Quality Assurance, Health Informatics, Health Information Systems.

1. Introduction

The European Commission's report on the socio-economic impact of interoperable electronic health record and prescribing systems concludes that it takes between six and 11 years to realize a cumulative net benefit; but when they come, the benefits can be significant (European Commission, 2009).

Despite this, investment in health information systems appears to be beset with problems. The British House of Commons Health Committee (2007 p3) suggested that:

Electronic patient record (EPR) systems have the potential to bring huge benefits to patients and are being implemented in health systems across the developed world. Storing and sharing health information electronically can speed up clinical communication, reduce the number of errors, and assist doctors in diagnosis and treatment. Patients can have more control of their own healthcare. Electronic data also have vast potential to improve the quality of healthcare audit and research. However, increasing access to data through EPR systems also brings new risks to the privacy and security of health records.

While the written clinical record may not provide adequate access to patient information (Tang, Fafchamps, & Shortliffe, 1994), these claims for health information systems ignore the fact that many of these functions exist without information technology (IT) and that increasing speed and improving the availability of information may serve organizational goals but not necessarily those of patient care.

Taking the medical doctor professional group as an example, some appreciate the benefits of health information systems (Hersh, 2002; Walsh, 2004) but most appear to resist their implementation, with reports in the literature being found from at least 1986 (Anderson, Jay, Schweer, & Anderson, 1986) up to the present (Ilie, Van Slyke, Parikh, & Courtney, 2009). The theme of these evaluations is that health information systems do not sit well with these clinicians' practices and that the interaction of different professional groups within an institution also plays a part in the resistance (Barley, 1986). …

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