NATIONAL INITIATIVES TO BUILD HEALTHCARE INFORMATION INFRASTRUCTURES

Significant sums of money are invested in information systems (IS) initiatives in the healthcare sector all over the world. Most countries have implemented Electronic Patient Record (EPR) systems, which are clinical IS that support documentation of examination, treatment, and care of patients. EPR systems are expected to raise the quality of care, reduce medical errors, cut waiting time and render the operation of healthcare more effective. Many of the expected benefits from EPR systems hinge on their ability to facilitate information sharing between healthcare providers. Consequently, many governments and healthcare providers have formulated national strategies to achieve a fully integrated information infrastructure building on interoperable EPR systems. In this paper we describe how the health authorities in Denmark have attempted to achieve interoperability through standardization of EPR systems in the so-called B-EPR initiative (i.e. Basic Structure for EPR).The initiative eventually failed and we argue that the main reason for this was too high ambitions along three dimensions: the geographical reach, the functional scope, and the temporal span. We argue that a critical look at the ambition level and associated strategies may contribute to formulating more modest targets. It is worthwhile to focus on defining strategies that specify how small and manageable initiatives can be extended and built on

National Digital Infrastructure and India’s Healthcare Sector: Physician’s Perspectives

Patient-centric digital infrastructure can potentially enhance the efficiency of healthcare systems. However, even in developed nations, evidence suggests low adoption rates for such infrastructure and lack of support from clinicians is considered as one of the most critical hindering factors. In this study, we examine physicians\u27 perceptions of the proposed large-scale information technology initiative in India that aims to transform the health sector and provide universal health coverage to all residents of India. We employed the information ecology lens to understand the broader changes in the healthcare system that could result from the initiative. We use focus group discussion and in-depth interviews to comprehend the perceptions of doctors about the initiative. Drawing upon Foucault’s conceptualization of power, we find that physicians, the key stakeholders in this initiative, are skeptical about the changes in the locus of power in the new ecosystem. Specifically, they perceive that knowledge power has shifted from a historical “expert knowledge power” to power related to “data management.” The physicians believe that changes are expected to manifest through monitoring, controlling, and managing the data rather than providing knowledge-based services. We present recommendations to engage physicians\u27 perspectives in implementing large-scale patient-centric digital infrastructure

Designing national electronic services in the public healthcare sector.

Papers 2 and 5 of this thesis are not available in Munin 2. Larsen, E. and LK. Johannessen (2014), 'Top-down or bottom-up? Building information system for healthcare', (manuscript) 5. Larsen, E. and G. Ellingsen (2014) 'Nothing free about free market', Rossitto, C. et al. (eds.), COOP Proceedings of the 11th International Conference on the Design of Cooperative Systems: COOP 2014 Nice, France, May 27 – 30, Proceedings of the 11th International Conference on the Design of Cooperative Systems, Springer: 69-85. Available at http://dx.doi.org/10.1007/978-3-319-06498-7_5This thesis deals with a socio-technical approach towards the development of inter-organisational ICT tools in healthcare. My overall case is Norwegian healthcare, and I investigated how national inter-organisational ICT tools were developed and why good results were difficult to achieve. Three public projects make up the basis of my data collection in which the main categories of data are interviews, participant observations and document studies. The data collection period spanned 2005 to the completion of this thesis. The main contribution of this thesis is the empirical insight into the long-standing establishment of inter-organisational health care services in Norway, a country that is characterised primarily by a publicly funded healthcare system. Studying this domain have demanded an inter-disciplinary approach because of the need to understand work practices, the implications of development and the complexities of information infrastructures, financing, project management, political governance and political philosophies. This study demonstrates how the strategies adopted by Norwegian authorities have changed. These strategies began as measures for invigorating the sector through the funding of public projects that establish specifications which vendors can use in developing new services. The strategies have transitioned into a top-down approach, with the Directorate of Health as the dominant stakeholder in a dedicated and specialised market. The recent strategy represents an approach that prioritises projects in a political process instead of basing such projects in extensive discussions in the healthcare sector. On the basis of the results, I suggest that a middle position be adopted in organising large-scale projects on integrated information systems. Such a strategy will give more power to the users of the information system. I believe that in real-world settings, a step-by-step strategy is favourable but requires good conditions for continued growth. Critical tasks are to break down large projects into a series of smaller ones, prioritise direct business value and assemble stable, full-time and cross-functional teams that execute these projects along a disciplined agile and optimisation approach