The document summarizes qualitative research on healthcare's fragmented ICT systems in Norway. Researchers studied several ICT integration projects and found huge expectations but modest results. The research examines experiences with electronic health records, mobile technologies, and other projects. It focuses on the socio-technical complexity where technological and organizational issues intersect. The research questions common views of seamless integration, implementation, and information flow. It provides examples of studies that offer realistic perspectives on complex work practices and information sharing challenges.

1. HEALTHCARE’S FRAGMENTED
ICT SYSTEMS -
HOW CAN QUALITATIVE
RESEARCH CONTRIBUTE?
Margunn Aanestad, Irene Olaussen, Miria Grisot, Espen
The FIPP project Skorve (IFI, UiO) and Gro A. Hamre (IDI, NTNU)

2.  FIPP project (Flexible Integration Processes in the
Public Sector) no. 176856
 Researchers have studied the attempts at integration of
care processes through the use of ICT in the Norwegian
healthcare sector
 Motivation: Huge expectations vs. modest results
 Participants:
 UiO: Margunn Aanestad, Miria Grisot, Irene Olaussen, Ole
Hanseth, Espen Skorve, Synnøve Thomassen Andersen
(Ingunn Moser, Fredrik Thele)
 NTNU: Eric Monteiro, Gro Alice Hamre (Knut Rolland)

3. Approach
 We examine the actual experiences, conditions and
consequences of a number of Norwegian healthcare
ICT projects
 EPR, mobile technology, telemedicine, patient charts,
automatic medication etc.
 Focus on “socio-technical complexity” (the way in which
technological, organizational and social issues are
intertwined)
 Utilises a cross-disciplinary approach
 Information Systems field, Computer-Supported
Collaborative Work, Science and Technology Studies

4. Recent anthology:
 Aim: contributing to a better
understanding of socio-
technical complexity
 We critically question a
number of widespread
conceptualizations and
understandings within the
sector:
 Seamless integration
 Implementation, pilot projects
 User participation
 Information flow
 Patient trajectory

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7. 1 book
2 editors
11 chapters
12 authors
178 pages
73.601 words
432.601 characters

10. Qualitative studies
 Context-specific and particular stories rather than
validation of models/propositions
 ”Anectdotal evidence”?
 We offer realistic exemplifications
 Generate awareness of socio-technical complexity
 … and we question and criticize conceptualizations
 Metaphors, models, understandings, beliefs

11. Example 1:
 Gro A. Hamre, Kirsti Berntsen & Eric Monteiro (NTNU):
 Chapter8: ”Kvalitetssikring av legemiddelhåndtering i et
samhandlingsperspektiv”
 Automatic packaging of (some) medication
 Multidose in Trondheim municipality
 Home care, pharmacy and GP
 Study of work practices, information tools and information
flow (processes of collaboration/information transfer
between parties)

12. Pharmacy’s list versus GP’s list – differences

13. Example 2:
 Ingunn Moser (Diakonhjemmet Høyskole):
 Chapter 3: ”Fra flyt til fluiditet: om metaforer for og modeller
av informasjon i helsefaglige praksiser og e-helseplaner”
 Does information flow?
 Studies of work with information:
 Information is often tentative, incomplete and materially
heterogeneous. It is shaped and exchanged within a collective,
and its relevancy is context dependent.
 Comparison with concept of information and information
flow in ICT strategies and programs

14. Example 3:
 Ann Therese Lotherington (NORUT Tromsø) & Beate
Nyheim (NST)
 Chapter 9: ”Å se, og se sammen. Produksjon av klinisk
kunnskap gjennom nettbasert sårveiledning”
 Cooperation between hospital and municipal care
teams on wounds
 Projectdefined package of tools: Digital camera,
standardised report form and web interaction
 Variable configurations of package and usage pattern
 What does implementation mean? Not ”roll-out”…

15. Example 4:
 Miria Grisot (IFI, UiO):
 Chapter 4. ”Ordningslogikker i informasjonspraksiser – en case
fra hjertetransplantasjon”
 Patient trajectory – principle to guide improvement and
re-organisation (e.g. standardised care paths)
 New (extended) conceptualizations:
 Multiple ordering logics:
 Patient focused
 Treatment focused
 Activity focused
 Result focused

16. Remaining questions:
 Description and awareness of complexity is only the
first step. The challenge remains:
 How to govern complex socio-technical systems?
 We need to identify governance models, i.e.
 Actor constellations
 Solution architectures and
 Development strategies
 that can deal with collective action dilemmas

17. … and finally:
 VERDIKT and IFI welcomes you to further discussions:
 13.00-16.00 Friday 26th November in Oslo
 Presentation of book, panel debate:
 Anders Grimsmo (NTNU/NSEP)
 Frode Lærum (UIO/AHUS)
 Anne Moen (UiO)
 Bjørn Afstad (Helse&Omsorgdept)
 Hans Nielsen Hauge (Helse Sør-Øst)
 Ole Hanseth (UiO)
 Free participation (but please register)
 See VERDIKT’s calender: http://tinyurl.com/36mjyca
 Thank you for your attention!