The Role of Integration in Health-Based Information Infrastructures

Abstract

Abstract. In this paper, we contribute with empirical insight into the complexity of establishing and sustaining integration between different information infrastructures in health care. An overall concern is to elaborate on how, despite many obstacles, the integration effort moves forward. We see this as a collective achievement, where users have an essential role in terms of mobilizing and coordinating the other actors as well as maintaining the integration. These activities are not limited to a specific project; they emerge from and are part of day-to-day practice. Empirically, we focus on a large integration initiative between the laboratory systems at the University Hospital of Northern Norway and the electronic patient records used by general practitioners in the Northern health region. Together with the vendor, Well Diagnostics, the hospital initiated a project aimed at establishing a new laboratory requisition system that enabled GPs to send requisitions electronically to the hospital laboratories. Theoretically, we draw on the concept of information infrastructures, and supplement this with Actor Network Theory.

Electronic medication management

“…A similar study in health care highlights the generative power of information technology and emphasizes the mutual shaping of work practice and formal tools that emerge in the interrelation of staff and artifact activities [2]. More recent studies in the field of CSCW have emphasized cooperative practices and artifacts as part of an information infrastructure [3,9,14]. What these studies have in common is that they explore different types of "ordering systems" (e.g., medication, laboratories, radiology) and highlight the ongoing work that actors and artifacts undertake to obtain a stable, cooperative arrangement in an interconnected, socio-technical network [1].…”

“…Several studies have illustrated the trade-offs and dilemmas of changing large-scale information infrastructures [3,9,14]. The power of the so-called installed base makes it difficult to change and control, due to its complexity and interconnectivity [14].…”

Accounting for the Invisible Work of Hospital Orderlies

“…One particular strategy relies on existing hospital plans, procedures, standards and classification schemes [6,22,47] that are used as coordination mechanisms or infrastructural arrangements, necessary to support the negotiation of heterogeneous networks [47]. Furthermore, the complex interrelation of heterogeneous actors and networks [7,18] constitute different hospital information infrastructures [17].…”

Computational Artifacts: Interactive and Collaborative Computing as an Integral Feature of Work Practice

“…The notion of 'computational artifact' was originally introduced by Lucy Suchman 3 in 1985 in a PhD-dissertation based on empirical studies at Xerox PARC and published as a technical report by Xerox PARC [37, pp. [iii], [1][2][3][4][5][6][7][8][9][10][11][12]. 4 The notion of 'computational artifact' occupies an important place in the foundations of HCI, CSCW, and related fields of computing technology research, not because it is widely used, far from it, but because it figured prominently in the incontestably most influential attempt to formulate a conceptual foundation for this kind of research, namely, Lucy Suchman's Plans and Situated Actions: The Problem of Human-Machine Communication.…”

“…It may also modify its own 'code' or regular behavior (or that of another running program) and do so in 'real time'. 9 Accordingly, the reactivity of computational artifacts obtained under the interactive computing paradigm is afforded by far more than simple operational speed; computational artifacts may change behavior quasi-dynamically as environmental conditions change. Reactivity thus also implies behavioral flexibility and variability.…”