Kathy Johnson, R.N., M.S., Project HealthDesign Ph.D. Candidate in Nursing, University of Wisconsin-Madison
Right now, we are witnessing the birth of a health information technology system architecture. Because of the complexity of this integrated structure, the evaluation of this process requires a great deal of thought.
The Health Information Technology Policy Committee (HITPC) recently solicited public comments on proposed meaningful use Stage 2 criteria [pdf]. May and colleagues’ Normalization Process Model provides theoretical guidance for this type of evaluation (May, et al., 2007). This model proposes that the evaluation of complex intervention implementations requires more than the measurement of outcomes and effectiveness; it holds that the social relations and processes related to the work that leads to those outcomes must also be considered. It emphasizes the processes by which complex interventions are made workable and integrated into everyday practice.
I argue that there is an implicit normativity, or reliance on common perceptions, in the emerging structures of the health information technology system. The proposed criteria for clinician meaningful use reflect only the clinical side of a system that is meant to be used by everyone. This approach to meaningful use is clinician-centric; the opportunity for patients to contribute health information in a format that is meaningful to them has not been addressed. Furthermore, efforts to evaluate the effectiveness of these systems have only been in terms of percentages of information bins filled; the only “meaning” in this rubric is the completion of a task.
Others may assert that there is nothing wrong with an implicit normativity by arguing that the professional is “in charge” of the patient and that the root purpose of the system is the provision of patient-centered care. If that is the case, then we are not moving toward a system that invites patients to participate in their care. Instead we are merely moving from paper to electronic documentation. Before us is a stellar and unprecedented opportunity to create a system that is meaningful for all.
- May, C., Finch, T., Mair, F., Ballini, L., Dowrick, C., Eccles, M., . . . Heaven, B. (2007). Understanding the implementation of complex interventions in health care: The normalization process model. BMC Health Services Research, 7, 148. doi:10.1186/1472-6963-7-148