Governing Innovation in E-Health Platform Ecosystems – Key Concepts and Future Directions

This paper conceptualizes knowledge in the IS literature on governing innovation in platform ecosystems using boundary resources. Platform innovation arises when platform owners realize the need to expand the functionalities and invite external actors with specialized knowledge to do so. We conduct a literature review to identify the relevant concepts on governing innovation in platform ecosystems in IS and adapt them to the specific settings of the eHealth context. As most relevant concepts, we identify: 1) boundary resources as governance mechanisms: openness vs. control; 2) co-creating platform innovation across heterogeneous actors: accommodation vs. resistance; and 3) platform innovation within the underlying architecture: stability vs. flexibility. We then derive areas that should be prone to further research in eHealth, defined as: 1) patient data as a resource for eHealth platform innovation; 2) the role of institutions in eHealth platform innovation; and 3) innovating within platform-oriented eHealth information infrastructures. This paper contributes by expanding the understanding of the current state of knowledge in IS on governing innovation in platform ecosystems and provides basis for further research adapted to the eHealth context settings

Benefits of Local Knowledge in Shaping Standards

This study investigates the pivotal role of local knowledge in shaping standards in the health service provision and health information systems implementation in the context of a developing country. To do so, we draw on empirical data from a qualitative case study of health data gathering and service provision during a child survival intervention campaign conducted in Ethiopia. Theoretically, we draw on studies that thematize the tension between the universal nature of standards or protocols and the inevitable need for adaptation and flexibility when they are implemented in a given concrete context. The study conceptualizes the national guidelines, which guide health workers in the data gathering and health service provision process, as standards. We examine the implementation of those guidelines in the actual set up, and show the significance of local knowledge in order to fit the standards to the reality at the ground. The findings indicated that health workers sometimes deviated from the standards and devised alternative ways of doing based on their context-specific knowledge and locally available materials. We emphasize both the need for standards as such, as well as the value of productive deviation from the standards when required depending on the context. The article provides theoretical insights relating to standardization with flexibility, and suggests differentiating between fixed and flexible elements of standards. We argue that the lessons learned on the data handling process observed in the campaign can help to improve the data quality and strengthen the routine health information systems

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

Collaborative Innovation in Healthcare: Boundary Resources for Peripheral Actors

Realizing the potential of digital technologies in hospital care requires collaborative innovation among multiple actors both within and beyond hospitals. Our research investigates the question: what does it take to foster collaborative innovation within a traditionally siloed and closed health information infrastructure? Empirical findings are derived from three cases, which we analyze by focusing on how innovation relates to interfaces with hospitals’ information infrastructures. We draw on literature on digital platforms and innovation ecosystems and focus on the notion of boundary resources to characterize these innovation interfaces. While this notion has mainly addressed the concerns of platform owners for ‘securing’ and ‘resourcing’ their platforms, our analysis also points to resources related to peripheral actors’ needs, specifically ‘discovering’ and ‘vesting’ resources. Discovering resources assist innovators in making sense of possibilities and limitations, while vesting resources relate to value appropriation. These resources are crucial for collaborative innovation in existing hospital information infrastructures

Polycentric Governance of Interorganizational Systems: Managerial and Architectural Arrangements

In an increasingly digital world, introducing new interorganizational systems requires establishing associations and relying on contributions of multiple actors that control existing technical solutions. This article examines the question: “how can large-scale system implementations across multiple organizations be governed in situations of distributed control over components?”. To answer this question, we present the findings of a longitudinal case study on the introduction of e-prescription in Norway over a 14-year period. The findings point to complementary architectural and managerial arrangements that make possible a polycentric governance approach. This work contributes to research on Information Systems Governance by providing insights relevant to mandating large-scale system implementations across organizations by mobilizing and orienting multiple contributors that control various pre-existing solutions

TELEMEDICINE IN PRACTICE From operating theatre to operating studio -visualising surgery in the age of telemedicine

2 Summary The introduction of communication technology into operating theatres involves significant changes and challenges. We have conducted a telemedicine project between two of Norway's largest hospitals (Rikshospitalet and Ullevaal hospital) with a focus on image-guided surgical and radiological procedures. Video was broadcast using a 34 Mbit/s ATM network. This resulted in changes in the local work practice to accommodate and facilitate the communication. It also required changes in the surgeon's work situation with regard to teaching in order to improve communication with remote viewers. These changes were non-trivial, and we see them as signs of a shift towards a more public kind of surgery and interventional radiology brought about by the technology. Introduction Once an operating theatre was literally a theatre, where dissections and operations were performed for the audience who were seated in the room around the table. This public aspect of surgery has for a long time (and for good reasons) been downplayed and limited to the teaching hospitals or to defined training programmes. However, visualisation of the surgical performance may be re-emerging as telemedicine is introduced into surgery. In this case the audience's presence is virtual, being mediated by the technology. This increases the flexibility immensely, because the audience may be distributed in space (remotely located) or in time (e.g. by broadcasting stored material from a database). The effect is that the operating theatre once more becomes a real "theatre", or perhaps "operating studio" would be an appropriate term

Configurable Politics and Asymmetric Integration: Health e-Infrastructures in India

Information Infrastructures typically evolve in an incremental fashion, through partly planned and unplanned processes. A significant mechanism of growth is when previously unconnected systems are integrated, facilitating the transition from networking to inter-networking. Conversely, failure to integrate systems contributes to the lack of evolution of the infrastructure. Integration seems crucial for evolving infrastructures; however, there is little consensus on what it entails, as can be seen when different connotations of ‘integration” are unpacked. In contrast to the dominant view of integration as a largely technical concern, our focus is on how political and institutional interests are embedded in efforts to achieve integration. More specifically, we explore strategies for institutional integration that take into account uneven distribution of political influence. The paper builds on empirical material from our ongoing (2001 – 2008) involvement with the problem of fragmented information systems in the health care sector in India. The case is seen from the perspective of one small actor offering free, open-source software that is already being used in several other developing countries. Choosing to focus on a small actor highlights the asymmetric power relations among the actors; our actor has no other option than to seek to align with bigger and more influential actors. We analyse the strategies, the configurable politics, and the outcomes of the distinct configurations that emerge from this form of asymmetric integration

A Frugal Approach to Novelty: Patient-oriented Digital Health Initiatives Shaped by Affordable Losses and Alliances

In this article, the concept of effectuation is introduced to address the question of how innovations in health service organisations arise, in what circumstances, and what mix of factors tends to produce adoptable innovations. Our case study investigates an ongoing initiative to introduce patient-oriented web-based services in hospital settings. In the analysis of the case we point to the relation between the technologies employed and the tactics identified. Our analysis emphasises (1) the role of thinking in terms of affordable losses, (2) the role of alliance building (3) the role of flexible web-based technologies. Building on these core aspects we thematise frugal approaches to novelty and we propose that the concept of effectuation can be useful for exploring change dynamics that transcend the organic/planned and grassroots/top-down divides

Institutionalizing Information Systems for Universal Health Coverage in Primary Healthcare and the Need for New Forms of Institutional Work

Today, many countries around the world focus on ensuring that all people can access health services of sufficient quality without experiencing financial hardship (i.e., universal health coverage). To measure progress towards this goal, countries need to build robust health information systems. Because countries need to root universal health coverage in primary healthcare, they also needs to sensitively anchor health information systems that support universal health coverage in existing routine health information systems. However, doing so involves significant challenges, which we study via empirically analyzing an Indian state\u27s effort to implement a universal health coverage health information system in primary healthcare. Using a theoretical lens informed by institutional theory, we seek to answer the question: “What is required to develop institutions that support the use of new technologies and associated work processes that universal health coverage entails?”. We identify the contradictions that emerge when new systems clash with existing ones, and we discuss what implications such contradictions have in terms of system design, work processes, and institutions. We contribute to the literature by explaining inherent complexities in universal health coverage health information system design and implementation and providing system design guidelines