VERDIKT conference 2010

1. The role of integration in health-based
information infrastructures
Gunnar Ellingsen
Department of Telemedicine and e-health
University of Tromsø
NO-9037 Norway

2. Research interests
DIPS Interactor (electronic laboratory requisitions)
Organization of national IT projects
(e-prescription)
Nursing care plans
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3. The talk
1. Research collaboration with DIPS ASA
2. Development and deployment of DIPS Interactor and
some of the challenges along the way
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4. 1. Research collaboration with DIPS
 Regional Communication (VERDIKT)
◦ Project type: BIP
◦ Project owner: DIPS ASA
◦ Partners: Sentrum legekontor as, Siemens Medical, Profdoc
Norge as, University of Tromsø and Norwegian University of
Science and Technology (NTNU).
◦ Funding from the Research Council 6.6 MNOK
 Tromsø Telemedicine Laboratory (Centre for Research
Based Innovation (SFI)
◦ http://www.telemed.no/ttl
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5. A team of researchers
 A team of researchers with
different perspectives on the
same fundamental questions
on how to implement and
deploy sustainable systems in
healthcare
 Qualitative approach based
on interviews and
observations
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6. Value for DIPS ASA
‖DIPS considers the ‗Regional Communication project‘ as a
contribution for developing new understandings of how
healthcare processes should be supported by information
systems. Through the close cooperation with researchers and
users in this project, DIPS gains significant knowledge for
further development of its process-oriented EPR systems‖.
Research Director Sigurd From in DIPS
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7. Dealing with different perspectives –
serving as ―go-betweens‖
 Negotiating access in different settings (users in clinical
settings, managers, vendors)
 Differences in perspectives and agendas
 Need to adapt the collaboration to the actual setting
◦ Product vs. Practice
 Obtaining insight knowledge about a practice, which can
be fed into the vendor‘s development process
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8. Formal results
 Journal publications are taken seriously by the vendor
◦ Johannessen, Liv Karen and Ellingsen, Gunnar (2009): Integration and
Generification—Agile Software Development in the Healthcare Market,
Journal of Computer Supported Cooperative Work, 18: 607–634
◦ Ellingsen, Gunnar. and Røed, Kristoffer. (2010): The role of integration in
health-based information infrastructures, Journal of Computer Supported
Cooperative Work
 But, come often too late for the concrete development
process
 Contributes to a conceptual understanding
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9. The results are often of a different
character than initial expectations
 Negotiation about what might an interesting focus
◦ Effects vs. understanding and conditions for use
 Difficult to predict what might happen
◦ Acquisitions in the market
◦ Moving from a focus on local implementation towards a focus on
scaling in the market
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10. To make ―our‖ contributions as go-
betweens work
 Not very useful to present results as a one-time event
 A need for being in close dialogue with vendors, users and
managers
 Co-location with the vendor
 Participation in the development teams (as well as among
the users)
 Participation requirement specifications
 Workshops, regularly meetings, DIPS forum
 Portfoliomanagment
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11. 2. Development and deployment of
DIPS Interactor
 Flexible integration between general
practitioners and hospital laboratories
 Initiated in 2006 by the University
hospital North Norway, Well
Diagnostics and general practitioners
 30 % e-requisitions in the Medical
biochemistry laboratory in 2009
 Sold to four Health Authorities and
currently part of a large-scale bid for
tender in two health regions
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12. The apparent problem – the paper-
based laboratory requisition
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13. Sending and receiving sample tubes
The GP glues a barcode label on the
sample tube
The barcode is scanned
in the laboratories
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14. The envisioned workflow
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15. Initial strategy for the integration
 Well Diagnostics wanted to clarify their responsibility
through well-defined interfaces
◦ ―Strictly speaking, according to our mandate we could have
delivered an electronic requisition from our communication
system [to the hospital] and then let go …‖ (Chief designer)
 Don‘t challenge other vendor‘s market shares
 Try avoiding organizational complexity
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16. The hospital‘s top management
 Real goal
◦ Wanted to improve work process
efficiency and quality
 Strategy
◦ Establish a common pre-analytic service
unit where all sample tubes could be
received, unpacked and distributed to
the proper laboratory
 Outcome
◦ Lack of laboratory-specific competence
in the new unit
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17. The Medical biochemistry laboratory
 Real goal
◦ To remove the key remaining
bottleneck in their workflow –
namely distribution and relabeling
 Strategy
◦ Acquired a distribution robot
(RSD 800A) from Roche
The distribution of sample tubes
 Outcome received from the GPs to sample
◦ Not possible to integrate the tubes adapted to a specific analysis
machine
robot in the laboratory portfolio
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18. The Microbiology laboratory
 Real goal
◦ Delimit receiving unclear and worthless requisitions from the
GPs, thus wasting a lot of resources in the laboratory
 Strategy
◦ To put some conditions on the requisition process, such as
requiring that the GPs included clinical information, type of
material and location on the body
 Outcome
◦ It became too difficult for the laboratory to identify and
implement specific conditions in practice
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19. The Pathology laboratory
 Real goal
◦ Modernise their internal paper-based in the laboratory
 Strategy
◦ Put pressure on the vendor of the laboratory system to make
improvements and adaptations
◦ Applied to Health Authority North Norway for reorganisation
funds
 Outcome
◦ Delays (partly) due to a lack of resources at the vendor of the
laboratory system
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20. The different agendas represented potential
controversies between the laboratories
 Difficult to agree on a common integration strategy
◦ The Microbiology laboratory wanted to use a laboratory
number that was shared with the general practitioners
◦ The Medical biochemistry did not
 Solved by local adaptations and engagement in
organisations issues
◦ Well Diagnostics (later DIPS) was to a large extent involved in
local adaptations, such as integrating DIPS Interactor with the
different laboratory systems.
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21. Implications for integration
 The notion of integration is not purely technical – it is also
organisational and context-dependent
 Big gaps between goals and results in IT projects
 Integration crossing different practices is hugely
underestimated and presupposes much longer time than
expected
 Integration need to be adapted to local (often diverging)
agendas
 Despite none of the laboratories have so far reached their
‖real‖ goals, they have got a platform to build on.
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