From IT Silos to Integrated Solutions. A Study in E-Health Complexity

In this paper we investigate the IT systems silo problem in e-health infrastructures. After three decades of user oriented systems development the health sector is characterized by system diversity and fragmentation. In response to this situation health authorities in the EU countries have called for a strategy of standardisation and integration; aiming to reduce complexity. It is assumed that this strategy will lead to less costly (through better co-ordination) and better health services (through more reliable data). Our research question is, how can we understand and manage the socio-technical complexity of large-scale integration in e-health? \ \ Our empirical evidence is a large e-health programme taken by the Southeast Regional Health Authorities in Norway, in order to reduce the number of systems and user environments. In particular we investigated the implementation and integration of an electronic patient journal system for 12.000 users. Considering our findings, and building on infrastructure and complexity theory, we find that the current approaches to resolve silo integration are relatively effective in reducing organisational complexity, but they may increase overall complexity over time.

An Implementation Process of Interoperability: A Case-Study of Health Information Systems (HIS)

Several advances have been made towards health information systems (HIS) use and implementations. However, these advances have not been matched by equal advances in HIS interoperability implementations. Current challenges in this domain are partly due to lack of implementation knowledge hence resulting into a number of failed HIS interoperability implementations. To gain substantive implementation knowledge on HIS interoperability projects, we have carried out interviews through an interpretive case-study approach to investigate a successful HIS interoperability project. Through this approach we propose an initial set of HIS interoperability implementation best practices comprising of these key processes: discovering interoperability need, projecting outcome, managing change and adopting an appropriate interoperability strategy which together depict a contingence management relationship. We conclude that this initial set of best practices contributes substantive knowledge that can guide future HIS interoperability implementations

Managing as Designing: Transforming Digital Healthcare Interoperability

Digital healthcare transformations promise improved overall quality healthcare and patient continued care among others. However, quality healthcare and continued patient care can be hampered by various challenges including insufficient collaboration among healthcare centers, and limited data exchanges between health information systems (HIS). Such challenges can be overcome through collaborative digital healthcare initiatives in which, HIS are designed with data exchange capabilities that enable healthcare centers to easily exchange patient information across boundaries. However, several existing initiatives are carried out in isolation, and there is limited practical knowledge on how to collaboratively manage and design HIS’ interoperability. Consequently, this study investigated a managing as designing (MaD) approach taken by a successful HIS interoperability initiative in Sweden. Data was collected mainly through interviews with key informants within the implementation team. Based on study findings, a MaD HIS-interoperability conceptual framework that can guide the management and design of future HIS’ interoperability was developed

Putting Interoperability on Health-information-systems’ Implementation Agenda

The increasing demand of past patient medical information at the point of care, creates new data sharing and exchange demands on health information systems (HIS). However, a number of existing HIS have data exchange challenges given that they are ordinarily designed as vertical silos without interoperability obligations. Yet, to have data exchange within HIS and across health facilities, participating systems ought to be interoperable. However, interoperability is usually not considered a key design requirement during HIS implementations. Therefore, relying on exceptional existing practices to create benchmark design knowledge, the author employs a sense making perspective to analyze how HIS implementers arrive at their interoperability design requirements. Through this approach, an initial set of interoperability design prerequisites for purposively designing HIS’ interoperability is proposed. These include: knowing who, knowing what, knowing how and knowing which. A further study implication is the use of a sense-making perspective in exploring system design requirements

More Than One Way to Solve the Healthcare Innovation Crisis With Digital Platforms. Various Forms of Platform Openness Impacting Primary Healthcare

Whereas open digital platforms drive innovation in industries, platforms in primary healthcare are mostly closed. Policy-makers have been looking for ways to open up primary healthcare platforms to stimulate collaboration and innovation and need to do so even more due to the ongoing COVID-19 crisis. Yet, there is not one way of opening up platforms in primary healthcare, just as it is unclear how different ways of openness can lead to more innovation. This paper analyzes the opportunities and challenges in realizing platform openness while examining alternative forms of openness. To answer this, we (1) conceptualize different forms of platform openness (sponsor-provider-platform-user openness), (2) examine how these forms of openness can resolve barriers to innovation, and (3) examine what challenges need to be overcome to realize that form of openness in practice, such as complexity in roles, regulations, and ICT infrastructure. The findings are relevant to structure further research on how platform openness leads to more innovations in healthcare

Investigating the IT Silo problem: From Strict to Adaptive mirroring between IT Architecture and Organisational Health Services

A crucial problem reducing efficient information flow within healthcare is the presence of siloed IT architectures. Siloed IT Architectures causes disruptive and disconnected information flow within and between health institutions, and complicates the establishment of qualitative health services to practitioners and citizens. In this paper, we analyze this challenge using a mirroring lens. Our research question is, how can we establish a supportive IT architecture that reduces the IT silo problem? Our empirical evidence comes from a case in Norway, where we analyzed a transformation initiative on the national, regional, and local levels. Our investigation into the IT silo problem contributes to the literature on information flow and IT architecture within healthcare in two ways. First, we find that strict mirroring that leads to sub-optimization and silofication, is a major cause for the presence of IT silos. Second, we demonstrate how adaptive mirroring – a modular strategy for combining global and local requirements in IT architecture – improves the changeability and manageability of IT architectures

The Implication for Organisation and Governance Through User-Drivern Standardisation of Semantic Interoperable Electronic Patient Record Systems

The increased demand for more effective sharing of healthcare information to support complex patient pathways crossing organisational boundaries calls for semantic interoperable process-oriented Electronic Patient Record (EPR) systems. It follows the need for common standards to ensure that information is understood and interpreted consistently across various contexts. A considerable body of literature has demonstrated that standardisation within healthcare has proven difficult to achieve. Moreover, standardisation processes have traditionally had a top-down approach, for which little attention has been paid to users’ work practices. The many failures of standardisation efforts have put focus into alternative standardisation strategies, in which one promising method is promoted through the emerging openEHR approach for standardising the content of the EPRs. A network of voluntary clinical users should have a prominent role in standardisation processes and running the process in a distributed and negotiated manner over the Internet. In this paper, we seek to give empirical insight regarding the evolving process of developing and implementing a sematic interoperable EPR system based on the openEHR framework, and the implication for organisation and governance addressed by the evolving process. We analyse the case through an information infrastructure perspective, and claim that user-driven standardisation of semantic interoperable EPR systems has to be supported by a multi-level organisational infrastructure, in addition to governance organisations that make decisions and monitor results and performances at different healthcare levels. The organisational and governance infrastructure has to be established simultaneously, but preferably, in advance of new development projects. Empirically, we have followed the interplay between the developing process of an EPR system based on the openEHR approach and a government-led establishment of an archetype repository

Enterprise Architecture in Healthcare and Underlying Institutional Logics: a Systematic Literature Review of IS Research

This paper reports on a systematic literature review of empirical studies in the information systems literature focusing on Enterprise Architecture (EA) in healthcare. 30 papers were selected for extended analysis. We utilized institutional logics as a theoretical lens and focused on the logics of IT professionalism, medical professionalism and managerialism. According to this lens, we identified three foci of interests. In addition, we utilized the institutional level as an analytical dimension. The logics of IT professionals and the purpose of organizational implications of EA were dominating. Generally, there is a need for more in-depth understanding for all logics, however, the logics of managerialism and medical professionalism need particularly more attention. Moreover, there is a need for more empirical research to understand how institutional logics for similar professions may differ across institutions. Finally, few studies on EA apply theoretical lenses, and EA research is immature in sense of theoretical contributions