Why Using Actor Network Theory (ANT) Can Help to Understand the Personally Controlled Electronic Health Record (PCEHR) in Australia

Abstract

Globally, healthcare reforms are being initiated to address the tremendous challenges facing healthcare systems. Without exception these reforms include the implementation of a variety of e-health solutions. Such e-health solutions are complex and have far reaching implications. In this paper, the authors argue that while these implementations and adoptions of e-health solutions are necessary, it is essential that an appropriate lens of analysis should be used to maximise and sustain the benefits of IS/IT (information systems/information technology) in healthcare delivery. Hence, in this paper, the authors proffer Actor-Network Theory (ANT) as an appropriate lens to evaluate these various e-health solutions and illustrate, in the context of the Personally Controlled Electronic Health Record (PCEHR), the chosen e-health solution for Australia.

Using ANT to Understand Key Issues for Successful E-Health Solutions

“…The PCEHR is a unique solution that sits between an individually controlled health record and a healthcare provider ehealth record. In addition, the PCEHR has a shared use and mixed governance model [4,18].…”

“…This is in response to immense pressures in various areas including changing patient demographics, financial implications, work force shortages, advancements in medical technologies and the need to provide efficient and effective patient centric healthcare delivery [3][4]. However, the benefits from such investments are yet to be realized.…”

“…Its processes are complex and more often than not require the extraction of multi-spectral data and information to make unstructured and intricate decisions in compressed time periods; which if erroneous can lead to unpleasant outcomes such as the death of the patient (ibid). The underlying assumption in support of the introduction of IT (information technology) generally, and e-health in particular, into healthcare service delivery is that by improving the ways of accessing and sharing information across healthcare systems and moving away from pen, paper and human memory towards a new environment, where key stakeholders (for example: service providers, consumers, government agencies and healthcare managers) can reliably and securely share information electronically, it will be possible to realize significant improvements in health outcomes and quality of care [4,6], help with cost savings, improve patient involvement and produce useable secondary data for further research and training [4,7]. However, such a transformation is not a straightforward proposition especially given the complex and multifaceted environment of healthcare service delivery not to mention the inherent complexities of healthcare operations [5,[8][9][10][11][12].…”

“…Wickramasinghe and Schaffer [3], among others, have argued that these kinds of interventions are intricate and far from simple and thus need to be evaluated with robust and rich theoretically informed techniques [4,[11][12]. Ramaprasad and Paul [13] developed an ontology to help understand the existence of the various IS/IT initiatives in healthcare and the consequent technology mediated collaborations that ensued.…”

eHealth-as-a-Service: A Service Based Design Approach for Large Scale eHealth Architecture

“…Using a centralised architecture, the PCEHR is an opt-in repository for aggregating summary health information (Deloitte, 2011). Muhammad, Teoh, and Wickramasinghe (2012) describe the PCEHR as a hybrid system that attempts to integrate the Personal Health Record (PHR) with a clinical Electronic Health Record (EHR) system. A key characteristic of the PCEHR is Internet based access to summary patient records which is shared by healthcare professionals (HCPs) and patients however, control of the record remains intrinsically with the patient.…”