Erling C. Havn

Pilot Implementation of Health Information Systems: Issues and challenges

OBJECTIVES This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment of new HIS. However, it is not uncommon for pilot implementations to fail in the sense that little can be learned from them. METHOD We employed an interpretive case study approach in attempting to throw light on the reasons why pilot implementations sometimes fail. We studied the (failed) pilot implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses. RESULTS Based on a comprehensive evaluation of the implementation process, we identify three major challenges that complicated the pilot project and eventually led to its failure, namely difficulties in (1) defining an appropriate scope for the pilot implementation, (2) coping with unanticipated technical and practical problems, and (3) ensuring commitment from test users and their managers. CONCLUSION Pilot implementations are a very useful technique for developing HIS, but also one that is very difficult to do successfully. It is sometimes assumed that pilot implementations are less complicated and risky than regular, full-scale implementations. However, pilot implementations are not just small-scale versions of conventional implementations; they are fundamentally different and they have their own complications and issues to deal with that make them hard to design and manage.

Exploring the role of network effects in IT implementation: The case of knowledge repositories

This paper seeks to analyze the role of network effects in relation to the adoption and use of systems for knowledge sharing in organizations and draws on recent developments within network economics to outline a theoretical perspective on the implementation of knowledge repositories in organizations. Findings from a longitudinal field study are presented to explore the concept of network effects in more detail. Commonly associated with economics, the concept of network effects can also be used in an organizational context to study adoption dynamics and use patterns when new information and communication technologies are introduced. The analysis of the field study data shows that knowledge repositories exhibit strong network effects, which can complicate the implementation process in multiple ways. The research is based on a single, in‐depth case study. Future research should study the role of network effects in relation to other technologies and organizational contexts. It underscores the need to be aware of – and try to manage – network effects when implementing knowledge repositories and other “networked” technologies. By and large, IS researchers have overlooked the role of network effects in relation to information and communication technologies in organizations. This paper begins to address this gap by focusing on the role of network effects in the adoption and use of knowledge repositories. It is suggested that the concept of network effects provides a useful theoretical lens in a number of other cases.

Improvisation in Information Systems Development

This paper discusses the role of extemporaneous action and bricolage in designing and implementing information systems in organizations. We report on a longitudinal field study of design and implementation of a Web-based groupware application in a multinational corporation. We adopt a sensemaking perspective to analyze the dynamics of this process and show that improvisational action and bricolage (making do with the materials at hand) played a vital role in the development of the application. Finally, we suggest that this case study provides an occasion to reconsider how we conceptualize information systems development (ISD).

Physicians’ Progress Notes

This paper examines physicians’ progress notes, an artifact that, in spite of its obvious importance in the coordination of cooperative work in clinical settings, has not been subjected to systematic study under CSCW auspices. While several studies have addressed the role of the medical record in patient care, they have not dealt specifically with the role, structure, and content of the progress notes. As a consequence, CSCW research has not yet taken fully into account the fact that progress notes are coordinative artifacts of a rather special kind, an open-ended chain of prose texts, written sequentially by cooperating physicians for their own use as well as for that of their colleagues. We argue that progress notes are the core of the medical record, in that they marshal and summarize the overwhelming amount of data that is available in the modern hospital environment, and that their narrative format is uniquely adequate for the pivotal epistemic aspect of cooperative clinical work: the narrative format enables physicians to not only record ‘facts’ but also—by filtering, interpreting, organizing, and qualifying information—to make sense and act concertedly under conditions of uncertainty and contingency.

Work orgainzation, integrated manufacturing, and CIM system design

Abstract This paper is based on ESPRIT project 1199: ‘Development of a Human-Centred CIM System’. The idea of human-centredness is discussed in relation to flexible integrated manufacturing and to the development and use of computer systems in individual and cooperative work. The paper discusses systems development techniques for individual users and cooperative work. The integration of computer systems is reshaping work organization darmatically, and a method for addressing problems of work organization during the development of integrated computer systems is described.

Designing Shared Electronic Records for Chronic Care

This paper reports preliminary findings from an ongoing research project on the development of IT support for communication and information sharing across institutional and professional boundaries within the Danish healthcare system. The project focuses on the treatment of patients with implanted ICDs (implantable cardioverter-defibrillator). These are chronic patients who usually see several different healthcare providers on a regular basis. The main findings so far are: (1) Most of the data produced and recorded as part of the care process are context-specific and often difficult to interpret unless you are an expert on the subject. Sharing these types of data across institutional and professional boundaries is not feasible. (2) Yet, it appears that a small subset of data can make sense across the different contexts and be of use to others. These data are good candidates for sharing. (3) In addition, there appears to be a need for creating new types of data specifically designed to meet the coordination needs across different contexts and expert domains. (4) The dilemma is, however, that the production of these new types of data must not require too much extra work.

Design and management of networked information systems

The globalization of markets, the intensified international competition, the development of industrial networks and the prospective massive investments in telecommunications infrastructure have spurred a tremendous interest in computer-based information systems networks. Recent management literature enthusiastically embraces new IT-inspired concepts like business process reengineering, telework, electronic markets, network organizations and even virtual workplaces. However, relatively little attention is given to the problems of actually designing, implementing ad maintaining networked information systems, if these problems are discussed at all.

Joint organisational and technical development of CIM-systems: An extension of the classic scandinavian approach

In Scandinavia theories and methods for cooperative design tools for the computer supported craftsman have been the topics for intensive research for several years. This paper widens the discussion by taking in the question of CIM and the reshaping of the division of labour, work organisation and manufacturing processes. The paper argues for an evaluation of methods and tools developed for very different aspects of integrated manufacturing.