Nursing Terminologies as Evolving Large-Scale Information Infrastructures

This paper describes the slowly evolving nature of large-scale terminology-based information infrastructures. The strategic aim of implementing standardized terminologies is to share and compare information within and across domain-specific and organizational boundaries. We are particularly interested in working classification systems focused on specific domains’ and classes, and even more specifically in reference terminologies with the capability to interconnect different existing classification systems. We examine this empirically through a threefold case based on data from three Norwegian university hospitals, where we also track a national recommendation of a reference terminology. The reference terminology, which was initially promoted as a means to achieve integration and harmonization, is increasingly perceived as competing with other terminologies. This “gateway” has been presented as a purely technical and politically neutral system, but may be more complex in reality: such integration processes require considerable adaptations, negotiations, and manual maintenance

Exploring the Emergence of Open Platforms in Healthcare: Design Considerations and Experiences from an Initial Case in Norwegian Primary Care

Despite significant efforts on improving interoperability of health information and lowering socio-technical cost of replacing clinical applications, healthcare organizations and professionals struggle with fragmented and non-interoperable Health Information Technologies. This paper describes the emergence of open platforms, which may alleviate challenges related to interoperability issues, weak integrations, siloed data repositories, and numerous legacy systems within healthcare. Using a proposed platform initiative in Norway, we explore the open platform phenomenon with a socio-technical lens, and highlights four key topics that have produced tension and merits consideration from the involved stakeholders: i) Procurement strategy and vendor neutrality, ii) Ability to facilitate flexible use, iii) The use of standards and separation of data and application, and iv) Strategies for development and governance of standards. We further discuss the related implications and design considerations necessary to support complex patient pathways and provide clinicians more flexible and effective systems