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INTRODUCTION

I can spend half of my day tracking down patients. I will hear somebody mention somewhere in the hallway about a patient with this condition, and they're not on my printout, so I've got to walk to every floor and say, "Do you have this patient?" And they go: "Oh, that patient's on the vascular service, but yeah, I think Dr. [Smith] already operated on him." It's ridiculous. When I take two days off or, God help us, if I take off one week's vacation, it takes me two days when I come back to find out what happened to the patient on the OR schedule. Did they in fact come in, when did they go home, why they canceled, where they are, what happened to them. It's a horror. I can't read a progress note; I can't read half of the orders. I mean, if it's a routine orthopedic patient, I know what they're going to order, I know what they're going to write, so I can read those. But if the patient develops a medical complication and I can't read that doctor's note, I don't know what he's saying in there.

Organization design theorists have discovered that information systems are beneficial not only for accomplishing individual tasks but also for achieving coordination between tasks.170 Information technology expert N. Venkatramen has argued that information systems facilitate coordination by providing a "uniform infrastructure of information" to all people who participate in a particular work process.171 An underlying argument is that the growth of information technology is widening the range of feasible organization designs through dramatic reductions in the cost of transferring information and the constraints of time and place for connecting people. Organizations can be flatter, with less need for vertical differentiation, when there are direct horizontal linkages across tasks and functions that are facilitated by IT. Rather than functional hierarchies to collect and transmit information between functions, information can flow directly, on an as-needed basis, among those who are directly affected by it.

The patient medical record is a longstanding means for exchanging information about a patient's condition among care providers. It traditionally has taken a paper form and has been affected by the limitations that accompany paper files. Medical records are bulky and are moved around from provider to provider with some inconvenience. Paper medical records cannot be used simultaneously by various providers, and so their use encourages discrete care providers to work in sequence rather than simultaneously on a patient, introducing delays into the process. Paper records are prone to being lost, and even when they are in the right place at the right time, critical information may be missing, illegible, or buried in the pile of paper.

Much organizational innovation in healthcare at the time of this study centered on automating medical records to improve access to critical patient information by care providers involved in patient care. Success ...

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