Tina Blegind Jensen

Building nation-wide information infrastructures in healthcare through modular implementation strategies

Initiatives that seek to realize the vision of nation-wide information infrastructures (II) in healthcare have often failed to achieve their goals. In this paper, we focus on approaches used to plan, conduct, and manage the realization of such visions. Our empirical material describes two Danish initiatives, where a national project failed to deliver interoperable Electronic Patient Record (EPR) systems while a small, local solution grew and now offers a nation-wide solution for sharing patient record information. We apply II theory, specifically the five design principles proposed by Hanseth and Lyytinen, to contrast the organization and implementation strategies of the two projects. Our findings highlight how implementation strategies differ with respect to how stakeholders are mobilized. We argue that the realization of nation-wide IIs for healthcare not only requires a gradual transition of the installed base, which current II theory advocates. Here we articulate and exemplify a modular implementation strategy as an approach that also addresses the challenges related to mobilization and organization of multiple stakeholders.

Using institutional theory with sensemaking theory: a case study of information system implementation in healthcare

Institutional theory has proven to be a central analytical perspective for investigating the role of social and historical structures of information systems (IS) implementation. However, it does not explicitly account for how organisational actors make sense of and enact technologies in their local context. We address this limitation by exploring the potential of using institutional theory with sensemaking theory to study IS implementation in organisations. We argue that each theoretical perspective has its own explanatory power and that a combination of the two facilitates a much richer interpretation of IS implementation by linking macro- and micro-levels of analysis. To illustrate this, we report from an empirical study of the implementation of an Electronic Patient Record (EPR) system in a clinical setting. Using key constructs from the two theories, our findings address the phenomenon of implementing EPRs at three levels: the organisational field, the organisational/group, and the individual/socio-cognitive level. The study shows how a rationalised myth of an efficient EPR system has travelled from the organisational field to the hospital ward and on to individual doctors. The findings also provide evidence of a strong human agency by showing how doctors enact their work practices and shape the use of the EPR system. The study contributes to IS research by showing the need to address macro-level structures, as well as individual interpretations and practical use situations, in order to identify how and why information systems are adopted by users.

Identity Orientation, Social Exchange, and Information Technology Use in Interorganizational Collaborations

Advances in information technologies IT are creating unprecedented opportunities for interorganizational collaboration, particularly in large-scale distributed projects. The use of advanced IT in such projects can foster new forms of social exchange among organizations and change the way organizations view themselves in the context of their relationships. Despite a wealth of research on IT use, social exchange, and organizational identity, little is known about how new IT and the enactment of related IT affordances within interorganizational contexts enable social exchanges and organizational identity orientations. To address this gap, we conduct multiple case studies that describe the changing use of two-dimensional computer-aided design technology and new three-dimensional modeling technologies by a leading metal fabrication company in the architecture, engineering, and construction industry. The case studies demonstrate that changes in the companys IT and the enactment of related IT affordances within variable interorganizational contexts enable new forms of social exchanges. These exchanges, in turn, provide the context for the rearticulation of the companys identity orientation. Based on these insights, we formulate a theoretical model to delineate the relationships between IT use, IT affordances, social exchanges, and identity orientation. We conclude by outlining the implications of our study and suggesting possible avenues for future research.

Design principles for achieving integrated healthcare information systems.

Achieving integrated healthcare information systems has become a common goal for many countries in their pursuit of obtaining coordinated and comprehensive healthcare services. This article focuses on how a small local project termed ‘Standardized pull of patient data’ expanded and is now used on a large scale providing a majority of hospitals, general practitioners and citizens across Denmark with the possibility of accessing healthcare data from different electronic patient record systems and other systems. I build on design theory for information infrastructures, as presented by Hanseth and Lyytinen, to examine the design principles that facilitated this smallscale project to expand and become widespread. As a result of my findings, I outline three lessons learned that emphasize: (i) principles of flexibility, (ii) expansion from the installed base through modular strategies and (iii) identification of key healthcare actors to provide them with immediate benefits.

Building National Infrastructures for Patient- centred Digital Services

Abstract Patient-centred digital services are increasingly gaining impact in the healthcare sector. The premise is that patients will be better equipped for taking care of their own health through instant access to relevant information and by enhanced electronic communication with healthcare providers. One initiative to provide such services to patients is the Danish national e-health portal, sundhed.dk, which is at the forefront of governmental initiatives and which serves as a unified hub between the various participants in the healthcare sector. Studying the evolution of sundhed.dk in light of information infrastructure theory, we highlight the enabling and constraining dynamics when designing and building a national infrastructure for patient-centred digital services. Furthermore, we discuss how such infrastructures can accommodate further development of services. The findings show that the Danish national e-health portal successfully managed to establish a solid foundation by means of providing direct usefulness and by building on existing information systems, routines, and governance structures in the healthcare sector. However, during this process, a number of unintended side effects appeared that have challenged the continuous development of the portal. We conclude that sundhed.dk needs to strike a balance between generativity and control to accommodate further development of services. Keywords: Patient-centred digital services, National e-health portal, Design principles, Information infrastructure.

Building National Healthcare Infrastructure: The Case of the Danish e-Health Portal

This case chapter is about the evolution of the Danish national e-health portal, sundhed.dk, which provides patient-oriented digital services. We present how the organization behind sundhed.dk succeeded in establishing a national healthcare infrastructure by (1) collating and assembling existing data resources, (2) repurposing and enhancing current data sources in the health sector, and (3) engaging a multiplicity of stakeholders. We argue that these activities represent three ways of capitalizing on the installed base that has led to the evolution and current situation of the e-health portal. At the same time, we show how these three modes come with a number of challenges for sundhed.dk in its pursuit of further innovation.

Mobilizing Government: Inter-Organizational Collaboration Using Open Social Media Platforms

The nature of inter-organizational collaboration between government and other stakeholders is rapidly changing with the introduction of open social media (OSM) platforms. Characterized by a high degree of informality as well as a blurred personal/professional nature, OSM can potentially introduce changes and tensions in the well-established routines of the public sector. This paper aims at shedding light on such changes, presenting findings from a study on the use of an OSM platform, WeChat, in an inter-organizational collaboration project between government, university, and industry stakeholders in China. Drawing on the framework of the theory of temporary organizations, we analyze data from interviews and participant observations to single out the characteristics of inter-organizational collaboration afforded by OSM. The findings outline the features of collaboration practices afforded by OSM in the four dimensions of time, task, team, and transition. Specifically, we report on new collaboration procedures that are characterized by an ad-hoc and non-linear management of time; a sense of shared commitment to the accomplishment of tasks; a serendipitous recruitment of team members based on expertise rather than on organizational affiliation; and a transition from formal to informal as well as from professional to private collaboration.