Integration and Generification—Agile Software Development in the Healthcare Market

Abstract

The aim of this paper is to contribute to strategies applicable to vendors who want to move their locally designed and highly integrated systems to a larger market. A further aim is to explore how such systems developed for a local practice, and tightly integrated with the existing infrastructure, can be adapted to a larger market. We analyse the socio-technical mechanisms in play, the roles that the vendor and the users have in order to facilitate this, and the delicate interplay in relation to the other vendors. The analysis draws on the CSCW field, notions of generification of packaged software products, and boundary work. We argue that this process involves boundary work in relation to the installed base, as well as to other vendors and users. We also argue that the roles of the actors involved change during this process. The case described in this paper is the evolution of a system in which general practitioners can order laboratory services from the hospital electronically. The system integrates the general practitioners' information systems with the laboratory information system in the hospital. The development of the system started out in close cooperation with one customer, but as it evolved more customers bought the system. The system has been designed in an iterative and evolutionary way using agile development methods.

From Artefacts to Infrastructures

“…There are obvious parallels with the 'Rikshospitalet' case above. In addition, in their JCSCW article, Johannessen and Ellingsen (2009) note the different challenges in the supply of health information systems that were designed initially for one setting but then transferred to other contexts and subsequently to a larger market. The generification strategies adopted by the supplier in their study bear striking resemblances to the generification strategies articulated over time by ERP suppliers:…”

Electronic patient record development in Norway: The case for an evolutionary strategy

“…A strategy here has been to implement OpenEHR archetypes [35], making it possible to define the content in the EPR in a dynamic way. Internally, DIPS ASA has implemented yet another organizational structure, where the development work is organized according to SCRUM team [36]. A goal of this has been to ensure more autonomy and productivity in the teams.…”

The Role of Integration in Health-Based Information Infrastructures

“…However, we believe that users also have a key role to play in mobilizing and coordinating the actors involved (including vendors) as well as maintaining the integrations in practice. The users' influence may typically increase when integration gains momentum in practice, enabling them to put more collective pressure on the vendors to achieve specific functionalities (Johannesen and Ellingsen 2009). In ANT terms, this enables us to see the act of integration as an ongoing distributed activity, which is not solely associated with only a few actors and a few systems in a particular project period.…”

“…At the same time, Well Diagnostics had managed to promote and sell Well Interactor to nine other hospitals in Norway (Johannesen and Ellingsen 2009). The largest of these was Ahus, a large hospital in the south that bought Well Interactor in June 2006.…”