Applying sense-making to integrated health IT: Renal care in the UK and Sweden

Information technology (IT) in healthcare combines opportunities for improved integrated healthcare delivery with barrierswhich include clinician resistance and low adoption rates. While national level initiatives are taken to promote electronichealthcare (e-health), it is at the grassroots level that their outcomes unfold. This paper employs sense-making theory toextend prior research on the implementation of health IT by investigating the introduction of IT into renal care units in theUK and Sweden. Issues such as management support, user training, usability of systems and perceived benefits of technologywere found to have a direct impact on users’ sense-making processes. The manner in which people make sense of imposedsystems has far reaching effects, as the gap between intended results and actual outcomes is not limited to disparities betweenmicro-level end-users alone, but spans multiple levels including higher authorities, as well as individuals at the grassrootslevel

Professional hybrids and perspectives on electronic health records as boundary objects : the case of the National Programme for IT organising vision

This thesis examines the uses of Electronic Health Records (EHRs) and challenges faced in their implementation in the context of England’s National Programme for IT (NPfIT), the biggest civil IT programme in the world (Brennan, 2007). Despite the huge investments and high visibility that characterised the NPfIT, its aim of national level EHRs was not achieved and the programme was dismantled after being in operation for nearly a decade. The concepts of ‘organising visions’ (Swanson and Ramiller, 1997), ‘boundary objects’ (Star and Griesemer, 1989), ‘technology frames’ (Orlikowski and Gash, 1994) and ‘professional hybridisation’ (Noordegraaf, 2007) are employed to explain findings from this research. The study uses qualitative research methods, drawing on documentary sources and 51 semi-structured interviews. Responding to the limitations of using solely organising visions (Swanson and Ramiller, 1997), this thesis studies the NPfIT using a dual lens combining organising visions and boundary objects to understand the dynamics between stakeholders of the NPfIT organising vision. This thesis presents the EHR itself as a boundary object, and illustrates the knowledge sharing capacity of EHRs across clinical boundaries. A key emergent finding is the presence of clinician-IT hybrid professionals - a group that has neither been subject to empirical research nor been given sufficient attention in critical projects such as the NPfIT despite their unique position that bridges the clinical and IT domains. This study presents key findings discussing the factors that support and discourage the emergence of clinician-IT professional hybrids

Applying sense-making to integrated health IT : renal care in the UK and Sweden

Information technology (IT) in healthcare combines opportunities for improved integrated healthcare delivery with barrierswhich include clinician resistance and low adoption rates. While national level initiatives are taken to promote electronichealthcare (e-health), it is at the grassroots level that their outcomes unfold. This paper employs sense-making theory toextend prior research on the implementation of health IT by investigating the introduction of IT into renal care units in theUK and Sweden. Issues such as management support, user training, usability of systems and perceived benefits of technologywere found to have a direct impact on users’ sense-making processes. The manner in which people make sense of imposedsystems has far reaching effects, as the gap between intended results and actual outcomes is not limited to disparities betweenmicro-level end-users alone, but spans multiple levels including higher authorities, as well as individuals at the grassrootslevel