title: IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands.
abstract: BACKGROUND
  Information Technology (IT) has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Health Policy and Management, Erasmus Medical Centre, Rotterdam, The Netherlands. m.demul@erasmusmc.nl
authors.forename: Marleen
authors.initials: M
authors.lastname: de Mul
authors.forename: Antoinette
authors.initials: A
authors.lastname: de Bont
authors.forename: Marc
authors.initials: M
authors.lastname: Berg