Robinson_whole_thesis.pdf (2.38 MB)
The dynamics of health information management in Australia: the emergence and shaping of a profession
thesisposted on 2023-05-27, 09:53 authored by Robinson, KM
This dissertation describes original research that explores, for the first time, the historiography and roles of Australia's Health Information Managers (HIMs). The ecology of health information management was examined to show how key societal and political influences have shaped the profession, and to identify the implications for HIMs of evolving organisational arrangements. In interrogating the profession's roles, a qualitative approach was used, incorporating face-to-face, in-depth interviews with an Australia-wide cohort of HIMs and ethnographic observation or in-depth interviews in three case studies. Scaffolded by the Foucaultian centrality of the medical record to medicine and the modern hospital, the drivers and contestations that shape HIMs' work hinge upon: standardisation; scientific medicine; bureaucratisation; technologisation; the hegemony of healthcare managers; the forces of the risk society exemplified in healthcare resourcing, performance, and quality of care accountabilities; health consumers' interests; and a nascent commodification of health information. The findings situate HIMs as a metaphorical keystone species in the health information ecology: they populate a critical interface between uncertainty and the indeterminacy of absence of information, and the clarity of knowledge and truth‚ÄövÑvp. They struggle constantly to impose order. Drawing upon Durkheim and Mauss, this is seen to be effected through the HIMs' purifying and transforming the 'mess' of the raw data of the performance of healthcare into the elegance and sacredness of interpretable, mobile codes and facts. They constantly traverse boundaries, negotiate, and form alliances with human and non-human actors. They structure and legitimate bureaucratic relationships to facilitate health surveillance, and commodify patients and their diseases. Their infrastructuring and technologising work thusly translates, classifies and qualculates the messy and the unclassifiable into the workable and the portable. The overarching problematic of the contemporary Australian health information management profession is three-fold. First, paradoxically and notwithstanding the centrality of their scientific work, the HIMs' ordering across the spectrum of information in healthcare is largely invisible. Second, technology proves a temperamental ally that demands constant updating. Third, the chasm between their dichotomous worlds of disorder and order is ever-widening, amid: increasing systemic dependence on their information production; intensifying environmental risk; multiplying standards; and increasing volumes of data. It is concluded that the profession has emerged as an organising device central to healthcare managerial, research, and medical interests. Occupying a trustworthy role, the HIMs' challenges lie in determining what is health information, governing its production systems, and (re-)constructing, reconciling, and disseminating critical informational outputs as the official facts of both patient and healthcare system.
Rights statementCopyright 2017 the author