Pick-n-mix approaches to technology supply : XML as a standard “glue” linking universalised locals

We report on our experiences in a participatory design project to develop ICTs in a hospital ward working with deliberate self-harm patients. This project involves the creation and constant re-creation of sociotechnical ensembles in which XML-related technologies may come to play vital roles. The importance of these technologies arises from the aim underlying the project of creating systems that are shaped in locally meaningful ways but reach beyond their immediate context to gain wider importance. We argue that XML is well placed to play the role of "glue" that binds multiple such systems together. We analyse the implications of localised systems development for technology supply and argue that inscriptions that are evident in XML-related standards are and will be very important for the uptake of XML technologies

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Actor-Networks and the Production of IS Success and Failure

The paper presents an Actor Network Theory (ANT) account of the development of a Web-based information system (IS) in an insurance company. As an industry-first e-commerce system that transacted insurance products direct to the brokers over the Web, the IS was highly praised by the broker community. Its outstanding success in the marketplace however has been tarnished by internal resentment and objections regarding development costs (over budget), delayed project completion (over time) and poor internal functionality. As a result the IS was seen concurrently as a great success by brokers and some company members (mostly those dealing with brokers) and a resounding failure by company managers. As the IS is of strategic importance for the company, its current unresolved situation and the lack of managers’ commitment to fund its future development, put company at risk and seriously threaten its future competitiveness. By drawing from the ANT account of the IS development we aim to answer How and Why did it come out that the IS became simultaneously a success and a failure? What are the roles of actors, both human and technical, in the production of the IS success and failure

Inter-organisational communication networks in healthcare: centralised versus decentralised approaches

Background: To afford efficient and high quality care, healthcare providers increasingly need to exchange patient data. The existence of a communication network amongst care providers will help them to exchange patient data more efficiently. Information and communication technology (ICT) has much potential to facilitate the development of such a communication network. Moreover, in order to offer integrated care interoperability of healthcare organizations based upon the exchanged data is of crucial importance. However, complications around such a development are beyond technical impediments. Objectives: To determine the challenges and complexities involved in building an Inter-organisational Communication network (IOCN) in healthcare and the appropriations in the strategies. Case study: Interviews, literature review, and document analysis were conducted to analyse the developments that have taken place toward building a countrywide electronic patient record and its challenges in The Netherlands. Due to the interrelated nature of technical and non-technical problems, a socio-technical approach was used to analyse the data and define the challenges. Results: Organisational and cultural changes are necessary before technical solutions can be applied. There are organisational, financial, political, and ethicolegal challenges that have to be addressed appropriately. Two different approaches, one ‘‘centralised’’ and the other ‘‘decentralised’’ have been used by Dutch healthcare providers to adopt the necessary changes and cope with these challenges. Conclusion: The best solutions in building an IOCN have to be drawn from both the centralised and the decentralised approaches. Local communication initiatives have to be supervised and supported centrally and incentives at the organisations’ interest level have to be created to encourage the stakeholder organisations to adopt the necessary changes

The Development of Government Information Infrastructure: The case of Government Cloud Computing in Oman (13)

This paper investigates the roles of institutional isomorphic mechanism in Information Infrastructure (II) implementation. It explores a type of cloud computing namely; Infrastructure as a Service in the context of its national government implementation in Oman. The research answers the following research question; how institutional isomorphic mechanisms impact the Cloud Computing Implementation? The findings revealed that institutional isomorphic mechanisms played a major role in the implementation of government Cloud Computing project in Oman and in particular the Coercive and mimetic mechanisms. Practical and theoretical implications of the findings are then discussed

Combining Actor Network Theory and Genre Theory to Understand the Evolution of Digital Genres

In this paper we argue that a combination of Actor-Network Theory (ANT) and Genre Theory can constitute a theoretical framework for understanding how digital genres evolve.Genre theory states that genres evolve over time through reciprocal interaction between institutionalized practices and individual action; that they develop from actors’ responses to recurrent situations, and are shaped around characteristics as content, form, functionality and purpose. Genres emerge out of practice and at the same time they shape that practice. While genre theory can describe the characteristics of a genre, it cannot handle the processof how a genre is formed and what powers and forces are involved in this shaping process. In order to address this problem, several authors have incorporated structuration theory into genre analysis. However, structuration theory can only catch these constitutional processes of genre in a very broad manner. As a genre is evolving and stabilizing over time in interplay with different actors, it goes beyond what is possible to explain only by means ofstructuration theory. Instead, ANT could work as a tool to capture the process of how a genre takes form in negotiations with different stakeholders. In this paper we discuss how genre theory and ANT can be combined in a framework for analyzing emerging genres. We applythis theoretical framework on an e-newspaper project that embodies a new genre in the making. We will here show how evolving genre characteristics are developed, formed andstabilized in a negotiation and struggle between the involved actors when they translate their interests in ways that finally are resulting in a new genre

Grassroots community participation as a key to e-governance sustainability in Africa

This article explores the theoretical sustainability of e-governance in Africa by assessing the nature of participation of stakeholders. It adopts an explanatory critique, drawing on perspectives debated in scholarly literature and based on reviews of country approaches. The exploration takes into account historical antecedents to participation in e-governance in Africa, revealing that dominant stakeholder interests effectively lock out the majority of citizens from active participation in e-governance, except as consumers of public services delivered through e-government. It considers the nature of attachment of stakeholders to e-governance projects. Global stakeholders increasingly have a low degree of attachment, while there is a relatively high degree of enrolment of local actors. The concept of e-governance remains solid, but is dispensable, since although government agencies have “embraced” the message of e-government, certain local actors are weakly mobilised. The policy process has failed to nurture the heterogeneity of actors, specifically grassroots actors, that is required for effective e-governance.http://link.wits.ac.za/journal/journal.htmlam201