Coordinating work in hospitals through a global tool: Implications for the implementation of electronic patient records in hospitals

Modern organisations increasingly have to face the challenge of increased complexity and specialisation. The specialisation of work requires professionals, people possessing specialised skills and often having a high level of education. Organisations that face this kind of problem are large hospitals. The implementation of Electronic Patient Records (EPRs) in these hospitals is accordingly expected to reduce complexity and curb specialisation by coordinating work among contexts and different types of users. The paper is based on a hospital department with several different professionals working together. The professionals successfully organise their work and the production of their reports according to a global classification system. This makes the case an illustrative example on how hospitals might take a starting point in EPRs through such a mechanism and may provide some strategies for the implementation of EPRs

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

Generification by Translation: Designing Generic Systems in Context of the Local

While the mechanisms of generification during implementation and use of large-scale systems are well known, this paper extends and analyzes the notion into the design phase of generic systems and provides insight into the associated socio-technical key mechanisms at play. The paper draws on the information infrastructure literature, and emphasizes how generic systems’ designs always face infrastructural challenges and opportunities in the development process. The paper illustrates how a vendor solved the infrastructural challenges by (to a large degree) lending on local practice, translating perspectives, and carefully adjusting their design strategy over time. We argue that our findings have implications for practice because they underscore the malleability of the collaboration process between vendor and users. First, we suggest that designing a generic system calls for a flexible vendor willing to change and adjust the development strategy along with the evolving project. Second, to strengthen the user-developer collaboration, we highly recommend giving the user-participants, at the very early stage of a development project, a basic understanding of software design, and raising their skills in making precise contextual narratives. Third, we emphasize the importance of the project management’s engagement in recruiting clinical personnel and in making it possible for the clinicians to participate in the project. Empirically, the paper presents the initial stages of a large electronic patient record (EPR) development project that has been running from 2012 in the North Norwegian health region and is due to finish in 2016

STANDARDIZATION IN NURSING PRACTICE: CROSSCONTEXTUAL INFORMATION SHARING

Cooperation and collaboration are an inherent part of the daily work performed at a hospital in general, and among nurses in particular. However, the technologies that support these work practises are still inadequate. In this case study, we explore the standardization process in nursing practice, and how standards are used across departments in a hospital environment in order to share information and knowledge. We explore what issues are at stake when standard care plans are used across organizational boundaries. Moreover, we examine the following: a) the adjustment of nursing classification in local practice; b) the tension between different standards; and c) the use of standard plans as a bridge to share information across various context

Infrastructural arrangements for integrated care: implementing an electronic nursing plan in a psychogeriatric ward

Integrated care is not a constant entity, but is much more situated and temporal in character. A new infrastructural system for integrated care should not be envisioned as replacing most of the existing information sources, but rather seen as an extension to the heterogeneous ensemble of existing ones