Rune Pedersen

The Standardized Nurse: Mission Impossible?

Socio-technical approaches, with their over-emphasis on situated and contextual differences, find it difficult if not impossible to account for ICT-supported standardization of healthcare work. Empirically, not all efforts of standardization fail. How can that be theoretically conceptualized, even when key tenets of a situated perspective are maintained? We discuss an interpretative case study where standardization of nursing work-to an interesting degree-has been achieved. We analyze the process of co-construction of the standards (i.e., standards in practice). Standards are partly imposed from the top, and partly enacted through the active involvement and ingenuity of users.

Infrastructuring in Healthcare through the OpenEHR Architecture

In Norway, a national initiative is currently aiming at standardising the electronic patient record (EPR) content based on an openEHR framework. The openEHR architecture, offers users the capability to conduct standardisation and structuration of the EPR content in a distributed manner, through an internet-based tool. Systems based on this architecture, is expected to ensure universal (also internationally) interoperability among all forms of electronic data. A crude estimate is that it is necessary to define somewhere between 1000 and 2000 standardised elements or clinical concepts (so-called archetypes), to constitute a functioning EPR system. Altogether, the collection of defined archetypes constitutes a backbone of an interoperable EPR system lending on the openEHR architecture. We conceptualize the agreed-upon archetypes as a large-scale information infrastructure, and the process of developing the archetypes as a infrastructuring effort. With this as a backdrop, we focus on the following research question: What are the challenges of infrastructuring in a large-scale user-driven standardisation process in healthcare? This question is operationalized into three sub-questions: First, how are the openEHR-based archetypes standardised in practice? Second, what is the role of daily clinical practice, and existing systems in the process of developing archetypes? Third, how may related, but supposedly independent infrastructuring projects shape each other’s progress? We contribute with insight into how power relations and politics shape the infrastructuring process. Empirically, we have studied the formative process of establishing a national information infrastructure based on the openEHR approach in the period 2012–2016 in Norway.

Standardizing Work in Healthcare Through Architecture, Routines and Technologies

This chapter presents an in-depth longitudinal study of hospital work. It discusses standardization after the introduction of a computer-mediated nurse–nurse/interdisciplinary handover in a cardiology ward and its effect on collaborative work activities. The standardization also plays out in the physical architecture adopted by the hospital, which impact on the “who” and “how” collaboration progress—the impact of standardized spaces. The chapter focuses on the constant strive in health care to make work practice more effective by employing an increasingly broader approach towards standardization. The number of involved standards is central. Typically for this have been the introduction of the electronic patient record (EPR) system and a following chain of standards made feasible through possibilities from using an EPR system. Sociomateriality is used to illuminate the fact that standardization efforts cannot be investigated as isolated efforts, rather as one of several social and material interconnected ones. Particular to the case was how the physician–nurse handover was made computer mediated, which involves or alter interdisciplinary collaboration in the handover process. Although increased efficiency has been successfully achieved, the chapter discusses how altering some work impacts other processes, especially interdisciplinary collaboration, social relations, and informal learning. Further, architecture has gained sparse attention in the standardization of work processes in health care. Architecture contributes to standardized work practice when striving for efficiency and also become a conflicting standard in interdisciplinary collaboration.

The Politics of Establishing ICT Governance for Large-Scale Healthcare Information Infrastructures

In Norway, the focus on interoperability and communication across healthcare practices has increased the need to connect ICT portfolios at different levels of healthcare, into large-scale information infrastructures (II).Governinghealthcarepractices is exceptionally complex, due to thediverginggoalsandpoliciesof theheterogeneousactors involved.Establishwell-functioning ICTgovernanceorganizations tohandle these large infrastructures is therefore important.Using informationinfrastructuretheory,andgovernanceliteraturefromtheISfield,thispapercontributes withempiricalinsighttothelongitudinalandpoliticalprocessofestablishingICTgovernancein ahealthcarecontext, reportingfromoneofNorway’s largesthealth ICTprojects,situated in the NorthNorwayRegionalHealthAuthorityin2012–2016.Ourfocuswasonthefollowingresearch questions:HowdoesorganizationalpoliticsshapetheprocessofestablishinganICTgovernance organizationinaheterogeneoushealthcareenvironment,andwhatdoesittaketoestablishsuchICT governanceorganization?