Building nation-wide information infrastructures in healthcare through modular implementation strategies

摘要

In this paper the authors focus on approaches used to plan, conduct, and manage the realization of national healthcare information infrastructures. The focus is based on the observation that in addition to national initiatives with long timeframes, other initiatives exist, often with a smaller scale. It has been observed that there seems to be an apparent success of technologically rather unsophisticated electronic patient record (EPR) systems, often implemented in the context of local problem-solving and short-term initiatives. The empirical material describes two Danish initiatives, where a national project failed to deliver interoperable EPR systems while a small, local solution grew and now offers a nation-wide solution for sharing patient record information. The authors apply information infrastructure theory to contrast the organization and implementation strategies of the two projects. The findings highlight how implementation strategies differ with respect to how stakeholders are mobilized. It is argued that the realization of nation-wide Us for healthcare requires a gradual transition of the installed base. (58 ref s.)