IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands

• Published in: International journal of integrated care Vol. 7; no. 2; p. e15
• Main Authors: de Mul, Marleen, de Bont, Antoinette, Berg, Marc
• Format: Journal Article
• Language: English
• Published: England Ubiquity Press 16-05-2007; Igitur, Utrecht Publishing & Archiving
• Series: Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries
• Subjects: Cameras; Data collection; Diabetes; eyecare; Glaucoma; Health care; Hospitals; Information systems; Information technology; integrated care; Integrated delivery systems; Medical personnel; Nurses; Optometry; Patients; Professionals; Research and Theory; skill-mix; standardisation; Technology; Netherlands
• ISSN: 1568-4156; 1568-4156
• DOI: 10.5334/ijic.189

Information Technology (IT) has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care.
IT and skill-mix change share an important precondition: the standardisation of work processes. Standardisation plays a crucial role in IT-supported skill-mix change. It is not a matter of more or less standardisation than in the 'old' situation, but about creating an optimal fit. We used qualitative data from our evaluation of two integrated-care projects in Dutch eyecare to identify domains where this fit is important.
While standardisation was needed to delegate screening tasks from physicians to non-physicians, and to assure the quality of the integrated-care process as a whole, tensions arose in three domains: the performance of clinical tasks, the documentation, and the communication between professionals. Unfunctional standardisation led to dissatisfaction and distrust between the professionals involved in screening.
Although the integration seems promising, much work is needed to ensure a synergistic relationship between skill-mix change and IT. Developing IT-supported skill-mix change by means of standardisation is a matter of tailoring standardisation to fit the situation at hand, while dealing with the local constraints of available technology and organisational context.