Reflexive Standardization: Side Effects and Complexity in Standard Making

Abstract

This paper addresses the general question proposed by the call of this special issue: "What historical or contingent events and factors influence the creation of ICT standards, and in particular, their success or failure?" Based on a case study conducted over a period of three years in a Norwegian hospital on the standardization process of an electronic patient record (EPR), the paper contributes to the current discussion on the conceptualization of standard-making in the field of Information Systems. By drawing upon the concepts of logic of ordering adopted from actor-network theory and upon reflexivity and the unexpected side effects adopted from reflexive modernization, the paper makes three key contributions: (1) it demonstrates the socio-technical complexity of IS standards and standardization efforts; (2) it shows how complexity generates reflexive processes that undermine standardization aims; and (3) it suggests a theoretical interpretation of standardization complexity by using ideas from complexity theory and the theory of reflexive modernization. These research questions are addressed by offering an historical and contingent analysis of the complexity dynamics emerging from the case.

From Artefacts to Infrastructures

“…The Medakis project (1996 -2003) was to establish Siemens' EPR (named DocuLive) in all the five largest hospitals in Norway. We focus here on the implementation at 'Rikshospitalet' (see Hanseth et al 2006), where the DocuLive system was intended to serve several ambitions. This was that it should include all clinical patient information, covering the needs of all users; it should be built as one single integrated system; it should enable better collaboration and coordination of patient treatment and care through electronic information sharing and exchange.…”

Hybridity as a process of technology's ‘translation’: Customizing a national Electronic Patient Record

“…The latter give clients the chance to get software that embodies 'best practices' and also standards such as technical, procedural, output oriented and terminological that enable coordination, prescribe work and provide a shared language that allows consistency of the messages being exchanged (Boulus & Bjorn, 2010;Brunsson et al, 2012;Hanseth et al, 2006;Hanseth & Lundberg, 2001;Timmermans & Berg, 2003;Timmermans & Epstein, 2010;Wagner & Newell, 2004;Yeow & Sia, 2008). Homegrown EPR systems are developed to the needs of a healthcare organization.…”

“…There is a substantial body of literature from Information Systems and Science and Technology Studies (STS) that discusses the outcomes, and to some extent the process, of EPR implementations at a local or national level (Brunsson et al, 2012;Davidson & Chiasson, 2005;Greenhalgh et al, 2008;Håland, 2012;Hanseth et al, 2006;Hanseth & Lundberg, 2001;Kallinikos, 2010;Jones, 2003;Lapointe & Rivard, 2005;Oborn et al, 2011;Pollock et al, 2003;Vikkelsø, 2005;Williams & Pollock, 2008). In most studies customization of EPR is presented as being confined to a single organization, the user, with other stakeholders, such as developers and suppliers, being external to it (Boulus & Bjorn, 2010;Oborn et al, 2011).…”

Quality of semantic standards

“…Another De Vries definition used by several others (Hanseth, Jacucci, Grisot, & Aanestad, 2006;Van Wessel, 2008) is: "Standardization is the activity of establishing and recording a limited set of solutions to actual or potential matching problems, directed at benefits for the party or parties involved, balancing their needs and intending and expecting that these solutions will be repeatedly or continuously used, during a certain period, by a substantial number of the parties for whom they are meant. "…”

“…Several standards are available, and an overview is given by Eichelberg et al (2005). Introducing an Electronic Health Record (EHR) is also seen as setting a standard (Hanseth et al, 2006), although it is a complex one and is not suitable for current standardization processes. With respect to standardization, the EHR is characterized by several problems (Sahay, Akhtar, & Fox, 2008):…”