Skip to main content

Advertisement

Log in

Seamless Integration: Standardisation across Multiple Local Settings

  • Published:
Computer Supported Cooperative Work (CSCW) Aims and scope Submit manuscript

Abstract

The pressure towards tighter or “seamless” integration of health information systems is a recurring issue with both practical and analytical relevance. It taps into a discourse in the IS literature in general and organisation and management science in particular. Unfortunately, the prevailing perception of integration in the IS literature is as a predominantly technical issue. The CSCW literature, however, is attentive to the socio-technical aspects of integration. Building on this – but supplemented with recent elaborations in science studies – we aim at exploring the unintended consequences of information systems integration. A user-led perspective implies emphasising the tailoring to local needs based on in-depth studies of the micro practices. We argue, however, that the condition for such an approach is radically undermined by politically motivated, regional changes towards integration with implicated standardisation. Enforcing order in the form of standards across multiple local settings, seemingly a prerequisite for tight integration, simultaneously produces disorder or additional work in other locations for other users. Empirically, our study is based on a large, ongoing integration effort at the University hospital of Northern Norway, specifically studying work practices and perceptions across multiple laboratories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  • Berg M. (1998) Medical Work and the Computer Based Patient Record: A Sociological Perspective. Methods of Information in Medicine 38:294–301

    Google Scholar 

  • Berg M., Timmermans S. (2000) Orders and Their Others: On the Constitution of Universalities in Medical Work. Configurations 8:31–61

    Google Scholar 

  • Bernstein, K., M. Bruun-Rasmussen, S. Vingtoft, S.K. Andersen, C. Nøhr (2005): Modeling and Implementing Electronic Health Records in Denmark. International Journal of Medical Informatics, vol. 74, pp. 213–220

    Article  Google Scholar 

  • Bishop, M.L., E.P. Fody and L.E. Schoeff (2005): Clinical Chemistry. Principles, Procedures, Correlations, 5th edn. Lippincott Williams & Wilkins.

  • Boochever, S.S. (2004): HIS/RIS/PACS Integration: Getting to the Gold Standard. Radiology Management May–Jun vol. 26, no. 3, pp. 16–24

  • Cabitza F., M. Sarini, C. Simone and M. Telaro (2005): When Once is Not Enough: The Role of Redundancy in a Hospital Ward Setting. Group 2005, pp. 158–167

  • Clayton P.D., Narus S.P., Huff S.M., Pryor T.A., Haug P.J., Larkin T., Matney S., Evans R.S., Rocha B.H., Bowes W.A. (2003) Building a Comprehensive Clinical Information System from Components. The Approach at Intermountain Health Care. Methods of Information in Medicine 42:1–7

    Google Scholar 

  • Davenport, T.H. (1998): Putting the Enterprise into the Enterprise System. Harvard Business Review July–August, pp. 121–131

  • Eisenhardt K.M. (1989) Building Theories from Case Study Research. Academy of Management Review 14(4):532–550

    Article  Google Scholar 

  • Ellingsen G., Monteiro E. (2003) A Patchwork Planet: Integration and Cooperation in Hospitals. Computer Supported Cooperative Work (CSCW) 12(1):71–95

    Article  Google Scholar 

  • Ernst & Young (2005): Helse Nord RHF – Etablering av felles IKT enhet. Advisory report

  • Friedman B.A. (2001) The Total Laboratory Solution: A New Laboratory E-Business Model Based on a Vertical Laboratory Meta-Network. Clinical Chemistry 47(8):1526–1535

    Google Scholar 

  • Frost P.J., Stablein R.E. (1992) Beyond Exemplars: Some Reflections on the Meaning and Practice of Research in the 1990s. In: Frost P.J., Stablein R.E. (Eds.) Doing Exemplary Research, Sage Publications, Newbury Park, CA, USA, pp. 270–292

    Google Scholar 

  • Ginneken A.M. (2002) The Computerized Patient Record: Balancing Effort and Benefit. International Journal of Medical Informatics 65:97–119

    Article  Google Scholar 

  • Golden-Biddle K., Locke K. (1993) Appealing Work: An Investigation of How Ethnographic Texts Convince. Organization Science 4(4):595–616

    Article  Google Scholar 

  • Grimson J. Grimson W., Berry D., Stephenn G., Felton E., Kalra D., Toussaint P., Weier O.W. (1998) A CORBA-based Integration of Distributed Electronic Healthcare Records Using the Synapses Approach. IEEE Transactions on Information Technology in Biomedicine 2(3):124–138

    Article  Google Scholar 

  • Grimson J., Grimson W., Hasselbring W. (2000) The SI Challenge in Health Care. Communications of the ACM 43:48–55

    Article  Google Scholar 

  • Hartswood M., Procter R., Rouncefield M., Slack R. (2003) Making a Case in Medical Work: Implications for the Electronic Medical Record. Computer Supported Cooperative Work (CSCW) 12(3):241–266

    Article  Google Scholar 

  • Hasselbring W. (2000) Information System Integration. Communications of the ACM 43(6):32–38

    Article  Google Scholar 

  • Heath C., Svensson M.S., Hindmarsh J., Luff P., vom Lehn D. (2002) Configuring Awareness. Computer Supported Cooperative Work 11:317–347

    Article  Google Scholar 

  • Klein H., Myers M. (1999) A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Quarterly 23(1):67–94

    Article  Google Scholar 

  • Kuhn K.A., Giuse D.A. (2001) From Hospital Information Systems to Health Information Systems: Problems, Challenges, Perspectives. Methods of Information in Medicine 40:275–287

    Google Scholar 

  • Latour B. (1999) Pandora’s Hope. Essays on the Reality of Science Studies. Cambridge, MA: Harvard University Press

    Google Scholar 

  • Law, J. (2003): Ladbroke Grove, or How to Thing About Failing Systems, Published by the Centre for Science Studies, Lancaster University. http://www.comp.lancs.ac.uk/sociology/papers/law-ladbroke-grove-failing-systems.pdf File published 2000, revised December 2003, last accessed April 2005

  • Law J., Singleton V. (2005) Objects Lessons. Organization 12(3):331–355

    Article  Google Scholar 

  • Lenz R., Kuhn K.A. (2001) Intranet Meets Hospital Information Systems: The Solution to the Integration Problem? Methods of Information in Medicine 40:99–105

    Google Scholar 

  • Lærum H., Ellingsen G., Faxvaag A. (2001) Doctor’s Use of Electronic Medical Records Systems in Hospitals: Cross Sectional Survey. British Medical Journal 323(7325):1344–1348

    Article  Google Scholar 

  • Mykkänen J., Porrasmaa J., Rannanheimo J., Korpela M. (2003) A Process for Specifying Integration for Multi-tier Applications in Healthcare. International Journal of Medical Informatics 70:173–182

    Article  Google Scholar 

  • Perrow C. (1984) Normal Accidents: Living with High-risk Technologies. Basic Books, New York

    Google Scholar 

  • Pritchard,P. and J.Hughes (1995): Shared Care. The Future Imperative? London: Royal Society of Medicine Press.

    Google Scholar 

  • Schmidt K. (2002) The Problem with ‘Awareness’. Introductory Remarks on ‘Awareness in CSCW’. Computer Supported Cooperative Work 11:285–298

    Article  Google Scholar 

  • Schmidt K., Bannon L. (1992) Taking CSCW Seriously – Supporting Articulation Work. Computer Supported Cooperative Work (CSCW) 1:7–40

    Article  Google Scholar 

  • Schultze U. (2000) Confessional Account of an Ethnography About Knowledge Work. MIS Quarterly 24:3–41

    Article  Google Scholar 

  • SHD (2001): Governmental Action Programme 2001–2003. Electronic Interaction in the Health and Social Sector “say @”. http://odin.dep.no/archive/shdvedlegg/01/04/Sitek046.doc

  • SHD (2004): Te@mwork 2007. Electronic Cooperation in the Health and Social Sector. National Strategy 2004–2007 for Norway. Norwegian Ministry of Health

  • Timmermans S., Berg M. (2003) The Gold Standard: The Challenge of Evidence-based Medicine and Standardization in Health Care. Temple University Press, Philadelphia

    Google Scholar 

  • Tjora, A. (2004): Maintaining Redundancy in the Coordination of Medical Emergencies. CSCW’04, November 6–10, 2004, Chicago, Illinois, USA, pp. 132–141

  • Tsiknakis M., Katehakis D.G., Orphanoudakis S.C. (2002) An Open, Component-based Information Infrastructure for Integrated Health Information Networks. International Journal of Medical Informatics 68:3–26

    Article  Google Scholar 

  • Xu Y., Zapletal E., Lemaitre D., Degoulet P. (2000) Integration of Medical Applications: The ‘Mediator Service’ of the SynEx Platform. International Journal of Medical Informatics 58–59:157–166

    Article  Google Scholar 

  • Van Maanen, J. (1988): Tales of the Field. On Writing Ethnography. The University of Chicago Press

  • Walsham, G. (1993) Interpreting Information Systems in Organizations. John Wiley

  • Winsten D. and J. McMahan (2000): Integrating Your Radiology Information System in a Complex Computing Environment. Radiology Management Jul–Aug vol. 22, no. 4, pp. 26–28

  • Winthereik B.R., Vikkelsø S. (2005) ICT and Integrated Care: Some Dilemmas of Standardising Inter-Organisational Communication. Computer Supported Cooperative Work 14:43–67

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful for the financial and intellectual support of the Norwegian Centre for Electronic Patient Records (NSEP, www.nsep.no). Discussions with colleagues, especially Ole Hanseth and Knut H. Rolland, have been most beneficial. We also appreciate the input from the reading group around Tord Larsen. The open and welcoming climate at the University Hospital of North Norway has been indispensable; without it this piece of research would never have been possible.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eric Monteiro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ellingsen, G., Monteiro, E. Seamless Integration: Standardisation across Multiple Local Settings. Comput Supported Coop Work 15, 443–466 (2006). https://doi.org/10.1007/s10606-006-9033-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10606-006-9033-0

Keywords

Navigation