There are three major information technology and information systems problems in the healthcare sector that have proved somewhat intractable: the universal electronic health record (EHR), also known as the electronic patient record (EPR) or the electronic medical record (EMR); the management and utilisation of large population‐based datasets; and the integration of research knowledge into evidence‐based practice. This book touches on all three but, unusually, from the perspective of the IS discipline and not health informatics, where these questions are usually discussed. This brings some very different analytical tools to bear on some fairly familiar problems, with varying results.
The book, which is a compilation of essays by mainly European and Commonwealth IS authors, is divided into a few introductory chapters which attempt to provide something of an overview, and then four distinct sections covering: standards and the process of standardisation in health information systems, transformation in healthcare chains, network organisation in healthcare, and knowledge management and health information systems. Within these sections there are essays of varying quality and value, and only those of more general interest are highlighted here. Many of the less successful offerings seem to have little understanding of the sector itself and contain superficial analyses of its particular character that leave the papers themselves very superficial.
In the Introductory section an account by Barnes of factors affecting the successful implementation of information systems in four UK hospitals provides some useful pointers to the need to gain stakeholder support, customise systems to local needs and integrate the project with organisational culture and objectives. In the section on standardisation Lundberg and Hanseth discuss some of the issues that surround the development and implementation of standards in healthcare systems, in this case the Digital Imaging and Communications in Medicine Standard (DICOM) and the Pictures Archiving and Communications Standard (PACS), which is more universally used. Political issues are as significant as technical ones in achieving standardisation, the authors suggest. Lagendijk and Stegwee outline some frameworks to better integrate standards used in health technology, terminology and communications areas that might help solve these problems.
The section on transformation in healthcare chains attempts to apply supply chain modelling and BPR to the health sector with mixed success. Administrative areas of the health sector are little different from other sectors, and where efficiencies can be gained by automating procedures the sector has already done it, as Klein and Schad demonstrate. However, where management decisions are affected by clinical concerns, issues other than efficiency dominate, and there has been far less successful uptake of systems in these more clinically‐oriented areas. This is demonstrated by Lagendijk, Schuring and Spil, who describe an electronic prescribing system that attempts to change prescriber behaviour while bringing efficiencies to the sector. The authors conclude that there are a number of issues to be resolved before the system brings widespread gains. An Australian system with more modest goals, confined to administrative and supply areas of the health sector rather than intruding into the clinical arena, appears to have been more successful according to an interesting report by More and McGrath.
In the section on networking, Chan and Ramsden describe a variety of heath information networks that link organisations in Canada, and Spanjers et al. describe networking within the hospital. The final section, on knowledge management, uses the term as it is applied in IS, not in health informatics. The first paper focuses on knowledge management as “developed management information systems” used in large enterprises in the health sector, while the second paper in this section, and the last paper in the volume, discusses some cases which demonstrate the use of management information in smaller practice organisations.
These two final papers demonstrate both the strength and the weakness of the volume. Its strength is that it successfully in many cases applies IS modelling to the health sector and demonstrates some areas where further analysis and research could improve systems in use or under development. Its weakness is that it does not display a very profound knowledge of the health sector, and at no time engages with the extensive literature dealing with these issues in the health literature. The analyses, where they have merit, are therefore less likely to have any impact on an industry that absorbs a very large amount of any developed country’s GDP and is rapidly developing extensive information systems. The book would have been immeasurably strengthened had any of the authors shown real understanding of the complex environment that makes up the health sector and the tension between clinical and managerial decision making.
Disappointingly, the book is very poorly edited, with poor English and some outstanding typos, and unattractive tables. On balance the IS discipline needs to do better than this to be taken seriously by the health sector.
