Countering the “dam effect”: the case for architecture and governance in developing country health information systems

Gebre‐Mariam, Mikael; Fruijtier, Elisabeth

doi:10.1080/02681102.2016.1214808

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…It seems unrealistic to place this burden on one NGO. Moreover, it could be argued that focus should start at the top, at FMOH and regional levels (Gebre‐Mariam & Fruijtier, ). Even then, the financial, technical, and political effort necessary to carry out radical organizational transformation requires a long‐term commitment.…”

Section: Analysis and Discussionmentioning

confidence: 99%

“…The poorly administered partnership between NGO and government organization in Ethiopia were also attributed to the informal or unstructured governance arrangements in the IOS implementation. This is also where misaligned strategies between interorganizational partners have emerged between the NGO and government constituents (Gebre‐Mariam & Fruijtier, ).…”

Section: Contributions and Implications For Is Researchmentioning

confidence: 99%

“…Unstructured interorganizational arrangements, due to lack of clarity about the distribution of decision rights, assigned roles, information flows, and overall coordination between stakeholders, have led to contradictory activities in the IOS implementation process. The lack of structure and prespecified coordination arrangements require dependence on mutual adjustment as a predominant coordination mechanism resulting in the IOS implementation process being susceptible to conflict and the shaping of the IOS in a way that is advantageous to opportunistic stakeholders (Gebre‐Mariam & Fruijtier, ). As a result of loosely structured organizational arrangements where coordination by mutual adjustment prevails, the study demonstrates that effectiveness of an IOS project and equity among interorganizational adopters can be compromised (Kumar & van Dissel, ; Payton, ).…”

Section: Contributions and Implications For Is Researchmentioning

confidence: 99%

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Governance lessons from an interorganizational health information system implementation in Ethiopia

Gebre‐Mariam

2018

E J Info Sys Dev Countries

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The paper investigates interorganizational health information system implementation in a developing country health sector and the influence of the sociopolitical context that constitutes the institutions of the global health system. It argues that a comprehensive understanding of interorganizational system (IOS) implementation should include the study of the institutional context and its stakeholders who exhibit complex social and political attributes that influences its implementation and trajectory.This paper charts this course by examining the key governance dimensions of coordination and alignment. Building on this, the study challenges the viability of the unstructured institutional arrangements and the ensuing development modalities for health information system implementation, which are largely facilitated by international nongovernmental organizations and leverage on information and communication technology. The paper concludes by discussing the implications of the study.These include (1) the influence of unstructured interorganizational relations, at both the organizational and sector levels, on IOS adoption, (2) how the social and political behaviors of opportunistic interorganizational participants are implicated in the IOS adoption process, and (3) the role of strategic alignment, largely driven by the informal interorganizational relationship and social dimensions, on the prioritization and fit between IOS technological and organizational components.

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Section: Analysis and Discussionmentioning

confidence: 99%

Section: Contributions and Implications For Is Researchmentioning

confidence: 99%

Section: Contributions and Implications For Is Researchmentioning

confidence: 99%

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Governance lessons from an interorganizational health information system implementation in Ethiopia

Gebre‐Mariam

2018

E J Info Sys Dev Countries

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“…Competition characterized by dominant logic is highly intensified in a resource‐constrained setting where technical and financial capacity heavily relies on multiple organizations. For instance, studies conducted in Ethiopia, India, Nigeria, and Ethiopia depict how organizations dictate the HIS implementation in India, Nigeria, and Ethiopia (Asangansi, 2012; Avgerou, 2004; Gebre‐Mariam & Fruijtier, 2018; Sahay et al, 2009). This case also depicts how different actors (managers, health experts, HISP, and partner organizations) with different IT perspectives and resources dominate HIS implementation at various levels of administration.…”

Section: Introductionmentioning

confidence: 99%

Exploring institutional logics to dynamic ambidexterity in health information system implementation in the public health sector of Ethiopia

Woldeyohannes

Gaynor

Assefa

2022

E J Info Sys Dev Countries

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Information system (IS) implementation can often lead to inherently contradictory issues, standardization, and evolve‐ability, which requires different, sets of information technology (IT) governance mechanisms. Recent research advocate ambidexterity mechanisms which consider the contradictory logic for long‐term success yet it has paid little attention to resource‐constrained settings which is a source of contradiction for the lack of technical and financial resource. Using an interpretative approach, based on institutional logic and dynamic ambidexterity concepts, this study revealed how centralized, systemic, and IT logics shaped IT governance mechanisms toward centralized and ad hoc‐based decentralized structures. Furthermore, the study depicted how the lack of a common vision for IS implementation impeded defining roles, identifying and collaborating with similar initiatives that led the implementation to uncontrolled evolve‐ability. Despite the absence of a common vision in resource‐constrained settings, the study identified the importance of resource‐chasing collaboration among heterogeneous actors to achieve standardization and evolve‐ability at a certain level though not sufficient. The study proposed an ambidextrous implementation framework by combining dynamic ambidexterity and institutional logic concepts to complement the resource‐chased collaboration with major HIS logics‐based collaboration through devising common vision, strategy, and mechanisms which allows sensing, seizing, and reconfiguring the emergent heterogeneous system implementation initiatives to achieve standardization and evolve‐ability simultaneously.

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“…In developing integrated referral applications, comprehensive application development planning can be facilitated by the development of enterprise architecture (EA) applications (IS/IT strategic planning) and data dictionary applications (data governance) [1]. EA can help healthcare facilities to overcome the complexity of the processes of healthcare facilities [12345]. According to Kettinger et al [6], the main purpose of EA is to help organizations share a common understanding within organizations and create a shared vision to align business areas with support areas and IT.…”

Section: Introductionmentioning

confidence: 99%

Health Referral Enterprise Architecture Design in Indonesia

et al. 2019

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ObjectivesIn this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals.MethodsThis research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes.ResultsThe EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS.ConclusionsThe proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.

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Countering the “dam effect”: the case for architecture and governance in developing country health information systems

Cited by 9 publications

References 22 publications

Governance lessons from an interorganizational health information system implementation in Ethiopia

Governance lessons from an interorganizational health information system implementation in Ethiopia

Exploring institutional logics to dynamic ambidexterity in health information system implementation in the public health sector of Ethiopia

Health Referral Enterprise Architecture Design in Indonesia

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