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- Larsson, Hannu, 1985-
(författare)
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Evolving structure in the implementation of healthcare information systems : an actor-network analysis
- 2011
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Ingår i: Electronic Journal of e-Government. - 1479-439X. ; 9:1, s. 30-40
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Tidskriftsartikel (refereegranskat)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.
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| 3. |
- Larsson, Hannu, 1985-
(författare)
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On the road to interoperability : Complexities of public sector enterprise thinking
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Increasingly, eGovernment (the use of ICTs in order to achieve better government) is moving its focus from web presence and electronic service provision to striving for an interoperable public sector. Interoperability refers to the ability for information exchange across organizational borders, concerning technology as well as business aspects. Policy for such change has been formulated and implementation is currently taking place in many government sectors. In such programs there is a strong need for coordination with regard to the way in which interoperability is to be implemented. Interoperability work requires coordination, as it is a complex endeavour because of the interrelatedness of information systems, public services, departments and organizations, as well as policies, constraints and regulations. In order to achieve interoperability, architectural approaches are increasingly used in the public sector to try to coordinate interoperability work. One such approach, Enterprise Architecture (EA), is becoming increasingly influential. EA has been defined as an overview of the complete business processes and business systems, both in terms of how they overlap and their interrelatedness. However, previous research show that state-of-the-art EA is seldom fully applied in practice. Previous research has also proposed that information infrastructures and architectures should be seen as evolving dynamically during the implementation process through changing relationships between actors. The implementation of IS architecture for interoperability is thus seen as an evolving process of social production. As the research field is still immature further research on the evolution of public information infrastructures and architectures is needed, as well as how the strategic alignment of handling of goals, and ambiguities in implementation is done. This thesis hence addresses the challenges of implementing national public sector interoperability as an evolving process by addressing the research question: How is interoperability interpreted and enacted by different actors in public sector implementation? In order to approach the research question, an interpretive case study is performed. The case studied in this thesis is from the implementation of the Strategy for eHealth in Sweden, where healthcare is mainly publicly funded, and catered for by 20 county councils (who mainly focus on healthcare, and 290 municipalities (who also cater for a great deal of other public services). The case is an example of how interoperability is implemented, from the early stages of outlining a general picture of goals and requirements, to the formulation of a strategy and an architecture. This case is also an example of how EA influences an interoperability program through enterprise thinking. The research uses an interpretive case study approach influenced by Actor-Network Theory (ANT). ANT is used as a toolbox for telling stories about technology in practice, as emergent in socio-material relations. A number of complementary qualitative methods are used. These include semi-structured interviews, observations and document analysis, with the foremost part of the empirical material being first-hand. In order to understand interoperability implementation in the public sector I examine the background to eGovernment implementation, by contrasting conceptualizations of eGovernment evolution to contemporary theories of public policy implementation. It is shown that, during the last decade, stage models have been used as tools for describing, predicting and directing the evolution of eGovernment. The stage model approach has been criticized for presenting a linear development which has little empirical support and delimits the understanding of eGovernment development as a dynamic process. Newer stage models have started to take this criticism into consideration and alternative models on eGovernment have also been developed. Consequently, eGovernment implementation is in this thesis perceived as a process in which technologies, policies and organizations are in a process of mutual shaping, where policymaking and policy implementation are intermingled. Implementing interoperability is hence not a matter of disseminating a policy that is to be implemented in every setting exactly as stated on paper, but a process in which the goals and means of interoperability are constantly being negotiated. Also, EA has been proposed as an approach to treat technology and business in the public sector as interrelated. However, since previous research show that state-of-the-art EA is seldom fully applied in public sector practice, the concept of enterprise thinking is developed in this thesis. Enterprise thinking is intended to be a concept that describes EA as a contemporary zeitgeist which in practice is adopted in varying ways. The results of the thesis show how interoperability in eHealth was roughly outlined before implementation although still containing conflicts and ambiguities. Central to this thesis is the controversy of defining “the enterprise”, as the health care sector was delimited as one enterprise, which became increasingly problematic during implementation. This to a large extent concerned municipalities, whose business area stretched much wider than just the health care sector, and hence the definition of the enterprise became problematic. Another central aspect was legal obstacles to cooperation, as there was a clash between the values of efficiency and patient privacy as a result of a new law that had been implemented in order to allow for information sharing. The legal grounds for sharing information proved to be problematic, which lead to that several involved actors perceived that a large portion of the patients in health care could not benefit from interoperability as their information could not be shared despite this law. The legal challenges also dampened the enthusiasm for the eHealth program as a whole. The program had also outlined a technology architecture before implementation. This architecture was however treated in conflicting ways, both as a blueprint (something to be implemented) and a tool for communication (as a way of discussing what was to be implemented). For instance, several municipalities perceived that the planned infrastructure was unsuitable to their business needs (as it did not meet the requirements of other actors in eGovernment), and thus questioned it, using it as a tool for communication rather than a blueprint. Meanwhile, other actors argued that the blueprint had already been decided, and thus needed to be implemented. The case also shed light on the use of informal networks, outside traditional bureaucracy, as a means to deal with interoperability. Such networks were used in order to align actions and perceptions of a large number of autonomous municipalities. This revealed issues concerning local decision as knowledge of, and resources for, ICT and architectural work was lacking in several municipalities. Also, as the networks lacked formal power no decisions could be taken jointly, but in the end had to be negotiated locally. This made coordinated decision making hard as the processes were lengthy and often lacked clear incentives. Furthermore, ambiguous feedback from national authorities, as well as an overall lack of understanding among local actors, concerning what was legal to do in terms of procurement and information sharing, complicated the situation further. These findings are summarized in four main conclusions; The process of defining which organizations are to be made interoperable, or what is to be considered as “the enterprise”, is a political process which might be brought into question and require re-negotiations throughout implementation, as the drawing of boundaries of “the enterprise” can be filled with conflict. Different perspectives on an enterprise, from different architectural viewpoints, are often described as complementary, and it has previously been shown that different architectural metaphors can be used by different actors during implementation. However, in practice, different use of metaphors for architectures can open up for discussion and conflict. These may not only be different, but may also contradict other actors’ use of metaphors, since different metaphors might clash. Interoperability work can be a novel task for some local governments. Therefore, there is a need for negotiation and to establish forms of formal decision making and informal dissemination because such structures might be lacking. It should be anticipated that implementation might be slow because of a lack of understanding about interoperability programs (particularly in terms of something other than ICT). In addition, there may be few forums for coordinated decision making, or there may be obstructions in the form of prior formal and legal arrangements. Enterprise thinking is interconnected with Enterprise Architecture as a zeitgeist for interoperability work. It draws upon EA as an ideal, whilst acknowledging that public organizations are influenced by this zeitgeist, although practical conditions might not allow for adoption of an EA approach. Enterprise thinking thus refers to the notion of EA as an ideal, not as a specific way of applying EA. Enterprise thinking has a process focus on interoperability. ICT, business goals, and work practices are perceived as interconnected, and hence need to be treated from a holistic perspective. How this is approached is, however, dependent upon the context in which it is implemented. Further research efforts could approach how enterprise thinking affects interoperability work in the long run with a longitudinal approach. Also, as this thesis has shown how the use of different architectural metaphors can clash, further research could focus on the positive and negative effects of negotiations being in
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