Co-innovation: the future of telemedicine in developing countries

Telemedicine which has been widely adopted in developed countries to reach all its citizens irrespective of their location is only being used for education purposes or disaster relief in developing countries. Since developing countries already suffer inadequate healthcare provision especially in remote areas, it would be essential to implement telemedicine practices for daily clinical uses rather than education use. This research argues that to understand the future of telemedicine in developing countries, both well-established technology innovations adoption factors as well as co-innovation factors should be addressed. In the context of healthcare provision, we propose a conceptual framework that integrates the healthcare resources and the organisational affiliations in co-innovation

Enterprise Architects’ Logics across Organizational Levels: A Case Study in the Norwegian Hospital Sector

In this paper, we report about a multilevel case study on the introduction of enterprise architecture (EA) in the Norwegian hospital sector. We utilize institutional logics as a theoretical lens, focusing on the enterprise architects’ logics that are underexplored in information systems research. We have col-lected empirical evidence at national (macro), regional (meso), and local (micro) levels. The findings are classified into nine categories with illustrative statements from the informants, demonstrating their reasoning about the contributions of EA. Furthermore, we identify tensions between enterprise archi-tects and managers and between enterprise architects and medical actors, which indicate the co-existence of multiple competing institutional logics. The most prominent tension is the paradox of EA—demands for local flexibility and autonomy at the micro level versus the predefined rules and standardization that EA imposes across all levels—which makes the institutionalizing process chal-lenging. The enterprise architect logics demonstrate similarities and differences across the various levels, indicating heterogeneity. We conclude this paper with a suggested persona of the enterprise architect, which illustrates the empirical findings

Institutional perspective on introducing enterprise architecture : The case of the Norwegian hospital sector

Paper I, II, and III are not available as a part of the dissertation due to the copyright.The findings from this thesis point to the incongruence between the characteristics of EA and the healthcare domain as specific tensions among the EA logic and different professional logics as a source of deviation. The incongruence comes from the long-term plan-driven EA approach versus healthcare traditions and needs for ad-hoc initiatives. Other themes stem from the EA logic of process standardisation, which poses challenges in gaining acceptance and trust that the processes dinscribe appropriate clinical knowledge and provide support for local variations. Moreover, the EA vision of data integration across organisational units and across IS has implications for concerns about privacy and protection of sensitive data, but this can collide with the healthcare view on patient safety and the need for mission-critical data. This dissertation makes several contributions to research and practice. First, it augments the EA research stream by offering rich insights and specific implications related to challenges of EA institutionalisation in healthcare. A description of the enterprise architects’ logics and the EA logic supplements the EA knowledge base. Likewise, it presents a model of a predicted evolution of the EA initiatives through the phases of optimism, resistance, decline and finally, reconsolidation of the most persistent ones, unless firm mandates are established from the start. Furthermore, the study provides a model that illustrates how coexisting institutional logics maintain their distinct character while allowing compromises that shape EA operationalisation. The model shows a set of scenarios for settling tensions in project decisions. In these scenarios, EA is foregrounded, blended with other available institutional logics or suppressed. Second, this dissertation contributes to an enhanced theoretical and empirical understanding of EA institutionalisation, where regulative, normative and culturalcognitive elements create and maintain EA as an institution, and unsurprisingly, the organisational response impedes the institutionalisation process. The organisational response can be explained by selective activated institutional logics among the actors. However, with targeted institutional work from the actors that want EA to be institutionalised, the process can be reinforced. This thesis also offers some practical suggestions at the national policy level. First, financial arrangements should be assessed to encourage broader involvement from the sub-organisations. Second, through active ownership, they can address the need for enhanced EA understanding and should secure the education of the actors, not the least at the executive level, together with the targeted hires. Furthermore, the need for organisational changes related to EA is under-communicated. The thesis also makes practical suggestions to deal with the challenges, the incongruence and the consequent tensions, mainly by finding solutions that balance between the institutional logics of EA and of healthcare.publishedVersio

Enterprise architecture operationalization and institutional pluralism: The case of the Norwegian Hospital sector

Enterprise architecture (EA) is a systematic way of designing, planning, and implementing process and technology changes to address the complexity of information system (IS) landscapes. EA is operationalized when architecture visions move towards realization through concrete projects. We report a case study on the dynamics of operationalizing EA in the Norwegian hospital sector by exploring different EA project trajectories. Our empirical context is an institutionally pluralistic setting where multiple logics coexist. We show that the distinct logic of EA is added to the institutional context and we find that tensions among existing medical, technical, and managerial logics and EA principles and assumptions emerge. We contribute to the under‐researched topic of EA operationalization by suggesting a model that demonstrates how the meeting of multiple institutional logics can lead to varying degrees of differentiation or even disassociation from EA visions during decision‐taking in projects. Furthermore, we advance extant research on IS projects' implementation in institutionally pluralistic settings by providing an empirical account of actors' interactions and project leadership arrangements that contribute to the persistence of coexisting logics in a dynamic equilibrium.publishedVersio

Preventive home visits among older people : risk assessment, self-rated health and experiences of healthy ageing

Background: The worldwide population is ageing and life expectancy is increasing. This increase in age is associated with physiological and psychosocial challenges and changes that lead to decreased intrinsic capacity and functional ability. To meet these challenges, preventive home visits have been reported to help older people meet their needs with regard to age-related changes, the intention being to enable older people to live at home for as long as possible. Although preventive home visits may have a positive impact on the lives of older people, it is still necessary to gain more knowledge not only about approaches and content, so as to optimise preventive home visits, but also about how older people perceive the ageing process and their need for support from the healthcare services and the environment. Aim: The aim of this thesis is to increase the level of knowledge about the content of preventive home visits to older people who are living at home and about how older people who live at home perceive the ageing process; the overall purpose is to contribute knowledge to help develop risk prevention and health-promotion activities within this population. Methods: The setting is three municipalities in Western Norway, representing a small, a medium and a large municipality. Older persons aged 75 and older participated in preventive home visits performed by trained nurses using a questionnaire. The questionnaire included questions and tests on falls, nutrition, polypharmacy and cognitive impairment as well as questions regarding lifestyle, health and medical diagnoses, including medications. Descriptive and inferential statistics were applied (Studies I to III), including logistic regression (Study II) and linear blockwise regression (Study III). Study IV used focus group interviews of participants aged 65 and older from the medium and large municipalities. The data was analysed using qualitative content analysis. Results: In Study I, 60% (n=166) of the invited persons accepted a preventive home visit invitation. The main reason for declining a visit was that the person was “feeling too healthy”. Thirty-six persons (21.7%) were identified as being at increased risk of developing illness. Study II showed that 34% were at risk of polypharmacy, 13% at risk of falls and 12% at risk of malnutrition. Of the 106 persons who completed the Mini-Cog test, 28% were at risk of cognitive impairment. Poor self-rated health was associated with increased risk of falls, malnutrition and polypharmacy as well as increased risk of developing illness. In Study III, the blockwise regression model showed that being limited by disease and had pain were negatively associated with self-rated health and that use of the internet was positively associated with self-rated health. The model had a R2 0.432. Being limited by disease was the variable that resulted in the largest change in the model (R2 Change=0.297, p-value < 0.001). Study IV suggests that most old persons enjoy life and they want to continue enjoying life for as long as possible. It is important to sustain networks and feel useful. Unexpected changes were described as threats, and the need to use healthcare services was associated with illness and being dependent. The results are categorised according to: embracing life, dealing with challenges and considering the future. Conclusion and implications: The findings from the overall study show that the focus areas of falls, nutrition, polypharmacy and cognitive impairment are relevant and should be assessed in preventive home visits for the purpose of risk identification. Self-rated health had associations with various risks and other factors related to everyday life. Therefore, self-rated health is suggested as starting point in preventive home visits for a personalised conversation regarding positive and negative factors in the older person’s life. The findings from the focus interviews show that social networks and activities are important in order for older persons to maintain good quality of life and to age well. Therefore, it is suggested that preventive homes visits are used to identify social needs and the ability to meet these needs. The findings also show that older persons did not included or wanted services from healthcare professionals as long they were feeling healthy. The older persons view their appreciation of social arenas and contributing to society as health promotion, and healthcare services and other sectors must contribute to health promotion in these areas

A Frugal Approach to Novelty: Patient-oriented Digital Health Initiatives Shaped by Affordable Losses and Alliances

In this article, the concept of effectuation is introduced to address the question of how innovations in health service organisations arise, in what circumstances, and what mix of factors tends to produce adoptable innovations. Our case study investigates an ongoing initiative to introduce patient-oriented web-based services in hospital settings. In the analysis of the case we point to the relation between the technologies employed and the tactics identified. Our analysis emphasises (1) the role of thinking in terms of affordable losses, (2) the role of alliance building (3) the role of flexible web-based technologies. Building on these core aspects we thematise frugal approaches to novelty and we propose that the concept of effectuation can be useful for exploring change dynamics that transcend the organic/planned and grassroots/top-down divides

Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study

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TECHNOLOGY INNOVATION IN THE FACE OF UNCERTAINTY: THE CASE OF \u27MY HEALTH RECORD\u27

In this paper we address the challenges faced when new e-health components are introduced within an existing infrastructural arrangement by focusing on the delicate balance between immediate usefulness and forward-looking preparedness. While e-health solutions are currently seen as a core element of on-going health sector reforms in most European countries, much of the challenges related to their design, development and implementation remain understudied. Based on an interpretive case study of technology innovation in the Norwegian healthcare context, we study the practices of building and putting to use a novel web-based platform for communication between users and providers of healthcare services. In particular, we analyse the conceptual design, the association with the installed base, and the relationship with users as core enacting practices of the project team members. We make use of the concepts of generativity and robustness to bring into focus and articulate possible approaches for change anticipation

INFRASTRUCTURES FOR PATIENT-CENTEREDNESS: CONNECTING NOVEL AND EXISTING COMPONENTS TO SERVE STRATEGIC AGENDAS FOR CHANGE

Web-based access to health services, health information and personal health records are increasingly offered to patients for enabling a new, more active patient role. However, incorporating such solutions into national health infrastructures poses challenges. In an information infrastructure perspective, the design of such technologies requires two main intertwined activities: designing ˜the new´ and dealing with ˜the old´ (i.e. the already established infrastructural arrangement). In this paper, we study such activities through the concept of institutional work to investigate how actors go about creating, maintaining and disrupting what was established in provider-centric healthcare. This is investigated in the context of an ongoing national initiative to design and develop a web-based, platform that will support shifting healthcare towards patient-centeredness. Analysing actors´ efforts for patient authentication , availability and comprehensiveness , we identify the pivotal role of activities that are about rearranging seemingly separate technological and institutional components

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design