Exploring the Formation of a Healthcare Information Infrastructure: Hierarchy or Meshwork?

Abstract

The digitalization of economic and social activity has brought information infrastructures (IIs) to the forefront of research. This paper studies II formation processes and their outcomes; namely, II architecture and distribution of control rights. We conduct an in-depth exploratory case study of an electronic prescription II and report on two formation processes: stratification and meshworking. The stratification process in our case study involved classifying the IIs' diverse socio-technical components into homogeneous groups and consolidating them into a coherent hierarchical structure that standardized the components' behavior. The outcome of this stratification was a dual and hierarchical architecture and a fairly centralized locus of control. The meshworking process, by contrast, assembled heterogeneous components without homogenizing them; the components were distributed in a way that enabled them to self-organize. The outcome of this meshworking process was a modular architecture that decoupled the central nodes from the users' installed base and a more decentralized structure. Consequently, the final II architecture was a hybrid offering both centralized control and autonomy of the parts. Our research further illustrates how this architecture then influenced the project's complexity and the actors' position in the sector. We build our contribution on extant II research.

Digital Trade Infrastructures: A Framework for Analysis

“…Until recently, IT artifacts covered by the term DI have been seen and approached as large-scale or global types of IT systems; and related methodologies and approaches have been tailored to address problems with the development of IT systems. However, a range of cases in the public domain have very poignantly demonstrated both the fundamental difference between DIs and global IT systems and the inadequacies of the approaches used for systems development to address the specific problems of DIs [17], [18], [19], [20]. Based on the fundamental argument that these new IT solutions need particular attention, researchers started to investigate the DI as a new type of socio-technical IT artifact.…”

“…Commonly in the DI literature, governance is seen as a combination of interactions between top-down and bottom-up driven processes. For instance, the Catalan electronic prescription information infrastructure (II) was shaped through the joint efforts of Catalan Health Services (representing the Catalan Ministry of Health) that initiated it and initially set the functional specifications for the building of the II and the Catalan Council of Pharmacists that ensured the effectiveness of the II for the regional pharmacies [20]. Similarly, Reimers et al [32] note that the government's willingness and ability to set standards, enforce inter and intra-organizational IS, and regulate the industry, led to II emergence in a de facto combination of top-down and bottom-up processes.…”

Information Infrastructures for eHealth

“…Such solutions can support aims for cost containment, enhancement of patient safety, control over doctors' prescription patterns and process quality assurance. Overall, putting e-prescription in place entails working with multiple and diverse sociotechnical components, finding ways to link and organise them (Rodon and Silva 2015).…”

The Anatomy of Digital Trade Infrastructures

“…However, a range of cases in the public domain have, in very painful ways, demonstrated the fundamental difference between DI and global IT systems and the inadequacies of following approaches used for systems development to address the specific problems of DIs (Damsgaard and Lyytinen 2001, Sauer and Willcocks 2007, Hedman and Henningsson 2015, Rodon and Silva 2015.…”