Investigating the IT Silo problem: From Strict to Adaptive mirroring between IT Architecture and Organisational Health Services

A crucial problem reducing efficient information flow within healthcare is the presence of siloed IT architectures. Siloed IT Architectures causes disruptive and disconnected information flow within and between health institutions, and complicates the establishment of qualitative health services to practitioners and citizens. In this paper, we analyze this challenge using a mirroring lens. Our research question is, how can we establish a supportive IT architecture that reduces the IT silo problem? Our empirical evidence comes from a case in Norway, where we analyzed a transformation initiative on the national, regional, and local levels. Our investigation into the IT silo problem contributes to the literature on information flow and IT architecture within healthcare in two ways. First, we find that strict mirroring that leads to sub-optimization and silofication, is a major cause for the presence of IT silos. Second, we demonstrate how adaptive mirroring – a modular strategy for combining global and local requirements in IT architecture – improves the changeability and manageability of IT architectures

Exploring loose coupling in system interaction

The concept of loose coupling is used in various disciplines, such as organisation science, computer science, information systems and geography, but its definition and application is elusive. In this paper we investigate the roots and meanings of the concept, and ask two research questions: (i) How is the concept of loose coupling used within streams of IS research? And (ii) how can we apply the concept to design the system interaction within the field of IS? Our method is a systematic review of the literature, where we identify the definitions and uses, conduct a cross-disciplinary meta-analysis, and deduct a framework for analysing and using the principle of loose coupling. We then discuss implications for the dynamics of information infrastructures. We offer two contributions. First, we provide a comprehensive overview of the loose coupling research, and gives rich insight into uses of the concept. Second, we propose a framework where we synthesize the insights

Process Innovation With Lightweight It at an Emergency Unit

In this paper, we are studying the role of lightweight IT in process innovation. Our research question is how can lightweight IT support process innovation within an established e-health information infrastructure? Our empirical evidence is a qualitative case study at a primary care emergency service in Oslo. We provide two contributions. First, applying the lens of business process innovation to the literature on information infrastructures, we retain the value of the installed base, while we at the same time ad speed to the implementation project. Second, we demonstrate the role of lightweight technology in improving logistics and message interaction within and between health units. The lightweight technologies availability on the commercial market makes acquisition and implementation faster. Based on this, we briefly suggest a bypassing strategy where a new layer of technology is built separately from the existing infrastructure in order to effectively address process innovation efforts

Patient treatment as enactment: Knowledge sharing across professional-lay divides

This thesis has two main aims, investigated in three research questions. The first aim is to investigate first how hospital professionals, like secretaries’, nurses’, and doctors’, knowledges is accomplished, used and distributed within the professional network, and secondly how information technology is used in these knowledge processes. The second aim is to look into how patients and parents interests are taken into account when performing treatment. The setting is the expert hospital Rikshospitalet, and the department of neurosurgery. An interpretive approach was used where interactions between hospital professionals, patients and parents were observed, and interviews performed later. The analysis is performed using aspects from knowledge theories like knowledge in practice, communities of practice, the difference between scientific and lay knowledge, as well as philosophical-historical elements related to the clinic. These aspects are analyzed using the theoretical framework of Actor-Network Theory (ANT). ANT enables an understanding of the treatment process as a network of action across different communities. The treatment is a relational process where different actors with different knowledges meet in order to attach necessary resources and perform treatment. The process is about obtaining partial alignment by taking into account different types of knowledges. If the doctor, and other clinicians, is able to see and understand the patient’s interests, and take them into account, it may improve treatment processes. Three different aspects are analyzed. First, the structure of success in the treatment process relates to the ability that the doctor has to switch between different ontological perspectives. If he is able to understand and integrate the patients’ interests, the enrolment succeeds. A second aspect regards what happens when the enrolment strategy fails, and suggests that this can happen because the professionals are not able to integrate knowledge perspectives in addition to the ones revealed by their technological apparatus (the medical gaze). The third focus is about how the increased amount of knowledge challenges the experts and their decisions. It is very difficult to identify new knowledge because it is continually created. This creates situations where experts make choices, but where patients can locate experts elsewhere who can do better. The thesis gives contributions to the area of health informatics and knowledge management. First it enables an understanding the knowledge used in treatment processes, and the challenges and problems different types of knowledge may lead two. Secondly it provides insight into aspects of lay knowledge amongst patients, and what information lay people use in order to secure their interests

Sense-able process innovation in digital health infrastructures

In this paper, we examine the role of IT in enabling and supporting process innovation at a general hospital in Norway. The motivation for our study is that fragmented and heterogeneous components of digital infrastructure in complex organisational settings hamper the ability to monitor and improve organisational performance through process innovation. Prior research indicates that loose couplings between traditional ‘heavyweight IT’ (resilient, secure, and stable) and ‘lightweight IT’ (consumer-oriented, context-aware and flexible) can support innovation. These principles have not been applied to process innovation. Our research question is, how can lightweight IT extend digital infrastructure to support process innovation, in hospital coordinative practices? We use the sense and respond framework from Overby et al. (2006) to analyze our case findings and derive a model for sense-able process innovation with lightweight IT. The model outlines how lightweight IT extends digital (health) infrastructure and affords an organisational ability to continuously sense and respond to the effects of process innovatio

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

Institutionalization of Digital Innovation Practices in Large and Complex User Organizations

Digital innovation (DIN) is crucial for managing the steady growth of resource use in the hospital sector. DIN includes the co-creation of novel services, such as digital remote care (DRC) solutions. Our empirical setting, consisting of 27 hospitals in Norway, is characterized by a complex organizational structure with an overall centralized IT governance, but not for the DRC initiatives. In the healthcare sector, there is limited knowledge of organizational practices to empower DIN at local levels in the intersection of central and local governance. Our in-depth case study exploring 70 different DRC trajectories reveals the interplay among three key mechanisms in a productive local DIN environment – idealistic entrepreneurship, organizational anchoring, and remote infrastructure – which reflect DIN practices. Our contribution to the DIN literature is a dynamic model showing the interplay among these key mechanisms, which increases the innovation pace, improves the innovations’ scalability, and makes organizations robust in implementing DIN practices

DISCURSIVE FORMATIONS AND SHIFTING STRATEGIES IN E-HEALTH PROGRAMMES

Research has shown that large IT programmes in e-government and e-health are challenging not only in terms of project failures and in terms of high costs, but also that the public and sectorial discourses greatly influences the trajectories and outcomes of mega-programmes. However, few IS studies have investigated this phenomenon in much depth, and the aim of this contribution is to shed more light on the relationship of discourse and mega-programmes. We use Foucault’s discourse concept to analyse discursive formations aiming to promote and establish solutions in e-health programs, but frame our investigation in information infrastructure theory. Our empirical evidence is a 15-year study of the growth of the national e-health infrastructure in Nor-way, where we analyse the interplay of the national eHealth discourse and the various programme initiatives. Our study offers two contributions. First, we demonstrate how the concept of discursive formation allows for an in-depth analysis of the role of discourse in large eHealth programs. Second, we show how shifts of discourse, combined with experienced problems in on-going programs, may disrupt the trajectories of large information infrastructures

The emergence of a national collaborative digital ecosystem. A study of one-citizen-one-health-record in Norway

Developing national e-health solutions has proved to be quite challenging in most countries. However, the coming of digital ecosystems have changed our understanding of how to deal with this type of large-scale socio-technical complexity. Platform ecosystems is not only a technical structure, but a new organisational form, which builds on a particular governance-architecture configuration. How can these insights contribute to improve the national e-health structures? How can we transform a fragmented e-health infrastructure into a national collaborative ecosystem? Our framework is the idea of a collaborative digital ecosystem, characterised by collaborative architecture and collaborative governance. Our empirical evidence is the gradual emergence of the e-health ecosystem of Norway, which we studied over a decade, from 2011 to 2022. We offer two contributions. First, we discuss how to orchestrate a collaborative architecture-governance configuration, focusing on complementary roles, the need for a self-reinforcing process, and the balance of control and autonomy. Second, we point to the role of attractors, i.e., architectural and governance elements that work as gravitational forces, in shaping of the ecosystem

Digital Platform Ecosystem Governance: Preliminary Findings and Research Agenda

This paper explores collaborative governance in digital platform ecosystems and the governance challenges that may occur in such environments. We analyze three different digital platform ecosystems and identify six unresolved key governance issues that we believe are central to the type of digital platform ecosystems we address. This paper has three contributions. First, we add to the literature on digital platform ecosystems by revealing a set of governance challenges regarding ecosystem forming and sustainability. Second, our findings may serve as recommendations for organizations that are planning to establish or that are already running an ecosystem based on a digital platform. Third, we contribute to digital platform ecosystem research by proposing an agenda for future research in this area