Exploring adaptive mirroring in healthcare IT architectures

Figures & data

Table 1. Data analyses.

Step|	Activity	Outcome
1	Identification of important events in national and regional e-health projects	Section 5.1- 5.2
2	In-depth analyses of an innovation project at a local hospital	Section 5.3
3	Structure the narrative according to organizational and technological changes. Identify and describe mirroring empirically	Section 5.1-5.3
4	Using the mirroring lens to derive and discuss general findings. Describe the process towards adaptive mirroring, as well as the adaptive mirroring architecture	Section 6

Table 2. Summary of the case and the action that changed the IT architecture.

Level	Reorganization	Relation between the organization and IT architecture
National	Centralized organization, local IT architecture	Strict local mirroring, no central management
Regional	Centralized IT Architecture	Strict centralized mirroring, limited local innovation
Local	Combined IT architecture	Adaptive mirroring

Table 3. Types of mirroring.

Mirroring type	Caused by	Consequences	Outcome
Strict local mirroring	Sub optimization, Siloification	Tight relation between local organizational units and experts, and the IT architecture	Local homogenization but overall fragmentation
Strict centralized mirroring	Centralisation, Centralized integration	Tight relation between central organization and the IT architecture	Extensive distance between practice environments and headquarter/IT unit
Adaptive mirroring	Splitting up and modularizing the architecture	The separation between central and local modules	Balances local configuration and centralized control

Table 4. Pros and cons of adaptive mirroring.

Pros	Cons
Improved conditions to facilitate a combination of local and central governance	Requires a more ecosystem-oriented governance regime.
Loosely coupled and modularised IT architectures to enable both centralised and local innovation	Requires transformation from monolithic to modular layered IT architecture
Better user services through more flexible and configurable interfaces	Needs a decentralised control system to ensure use maturity

Figure 1. Adaptive mirroring architecture.