Evolving Structure in the Implementation of Healthcare Information Systems: An Actor‑Network Analysis

Abstract

Public sector ICT use is now moving towards integration of services and processes across departments, for instance in the healthcare sector. This is a challenging issue as it involves distributed decision making, often across both public and private organizations, which implies a multitude of issues. Enterprise Architectures (EA) aim at providing a common framework that includes data, resources and processes, through which all aspects of the enterprise can be directed towards a common goal in an efficient manner. It as been argued that architectures should be perceived as evolving (rather then as carefully planned roadmaps), although more research on how EA evolves is needed. This paper addresses the general question of, how does an EA evolve during implementation? A case study is used to illustrate how an EA evolves throughout the process of implementation. The case is the implementation of a national patient record system in the decentralized Swedish healthcare system. The project is part of a larger effort to implement an EA in the healthcare sector aimed at further integrating the whole sector. Data is collected by means of observations, interviews and document analysis. Using an Actor‑Network Theory perspective, this paper presents four episodes during which an EA evolves through interactions. In this way the paper contributes with a deepened understanding of how EA evolves by arguing that EA programs should be seen as something that needs to be planned with regard to that it will, and should, evolve in order to respond to needs discovered in the process. The contribution is a deepened understanding of how sub‑projects co‑evolve with a national EA project, thus mutually affecting each other. This should not be perceived as something unequivocally negative as this might also be strategic, and leads to evolution of other parts of the EA to suit each other.