The Slight Surprise of Integration

Abstract

A b s t r a c tWestern hospitals of some size are characterized by a proliferation of nonintegrated information systems, resulting in considerable frustration both among users and information technology personnel Consequently there have been many integration efforts. Such efforts typically include some or all of the four principle classes of hospital-based systems: electronic patient records, laboratory systems, radiology systems and patient administrative systems. In this study, we trace the implementation process during most of 2004 at the University Hospital of North Norway, where these systems were part of a larger replacement project. We analyze the images and visions of order and perfection serving as a foundation for the decision to replace the existing IT portfolio. Furthermore, we analyze the manner and form in which unintended consequences of the integrated solutions appear and, finally, how the very act of integration may indeed produce rather than curb disorder. As a result, a lack of integration of any reasonably complex information system is an immanent feature. K e y w o r d s Hospital information systems, EPR, integration, order perfectionPart 4: Development Issues

Ontology definition and construction, and epistemological adequacy for systems interoperability: A practitioner analysis

“…For example, a study of systems integration/interoperability in the Norwegian healthcare sector found that increasing efforts to integrate systems was actually counterproductive [10, p. 276]. A conclusion of this work was that disorder is an inherent feature of integrated systems and that, in effect, the more time and resources devoted to joining systems together, the worse the result for the end-users [10]. These findings build on earlier research which suggests, for example, that unless database administrators have a priori knowledge of every context in which their systems will be queried, then the effort of ontological modelling does not match the anticipated reward of system interoperability [11, p. 9].…”

Data work: A condition for integrations in health care

“…This approach is too simplistic, reflecting a view that integrations are a clear-cut technical task. 4,5,7,13 Clearly, this does not take into account the implicated organizational work that is associated with integrations.…”

“…In the hospital wards, an integrated solution is supposed to give clinicians easy access to data from multiple information sources, thus providing a complete picture of the patient’s/client’s medical history. 13 Many challenges exist in this regard. Integration typically implies interconnecting systems developed with different tools that reside on a variety of technological platforms 14 and that are developed for very different purposes.…”

National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study

“…Thus, we were able to tell a more complete story of the process by which the new policy of the 4 hour wait target and an emergency department adapted to each other at the local organisational and professional context [ 62 , 63 ]. We paid particular attention to unintended consequences as they revealed the strength of mutual dependencies between the social and technical elements that hold this new way of working together [ 64 ] and, provided an opportunity to investigate their role in shaping the outcomes of this organisational change [ 65 ]. In this case, it helped us to understand how space, time and information technology can be manipulated and mobilised.…”