Why is it difficult to achieve e-health systems at scale?

ABSTRACT

This paper examines some of the current challenges surrounding the implementation of information and communication technology systems to support the delivery of care within health services. These highly complex electronic information infrastructures support an increasingly broad array of functions and actors. They are being supplied in the UK National Health Service by commercial vendors as Commercial Off-The Shelf solutions. Vendors have struggled to develop generification strategies that can accommodate the diverse practices and requirement of adopter organisations within their more-or-less standardised packages. At the same time there is enormous demand for improvements, coupled with a huge reservoir of potential innovations particularly where health practitioners interact with technology entrepreneurs. However, many outcomes of this bottom-up innovation process have struggled to be taken up more widely. As a result there has been markedly uneven progress in achieving radical visions that are being mapped out of how technology might transform healthcare.

Drawing insights from Science and Technology Studies and related Information Systems research, the paper explores conceptual frameworks and methodologies that may help us better understand these challenges: the barriers to exploiting local innovations and taking them upon a wide basis and the tensions that need to be managed in the process.

KEYWORDS:

• e-Health
• organisational studies
• domestication of ICTs
• ICTs

Acknowledgments

This article derives insights from the author’s participation in a study: Investigating the implementation, adoption and effectiveness of ePrescribing systems in English hospitals: a mixed methods national evaluation, funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-1209-10099) and led by Prof Aziz Sheikh. The author particularly acknowledges the value of discussion in the WorkPackage 1 research team: Kathrin Cresswell, Lisa Lee, Zoe Morrison, Hajar Mozaffar and Ann Slee. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health or the NIHR ePrescribing Programme Team.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Robin Williams is Professor of Social Research on Technology in the School of Social and Political Sciences and Director of the Institute for the Study of Science, Technology and Innovation (ISSTI) at the University of Edinburgh. Building on research into the ‘social shaping’ of enterprise systems and various other Information Technology applications, he is developing with co-authors the Biography of Artefacts perspective to address the design and implementation of information infrastructures. Recent books include Social Learning in Technological Innovation: Experimenting with Information and Communication Technologies (Edward Elgar: 2005) with James Stewart and Roger Slack, and Software and Organisations: The Biography of the Enterprise-Wide System ‒ Or How SAP Conquered the World (Routledge: 2009) with Neil Pollock and How Industry Analysts Shape the Digital Future (Oxford University Press: 2016) with Neil Pollock [email: [email protected]].

Notes

1. We note here that conventional languages of ‘organisation’ map rather poorly to health services which themselves comprise complex organisational assemblages with often-fuzzy boundaries and overlapping constituencies.

2. One element of the weakness of the UK e-health learning economy, which we will attend to in future work, concerns the strength of health professional roles. As a result, health professionals who have been seconded to e-health development and implementation projects tend to return to health practice. Their expertise and experience in how computer solutions may be configured to support health practices are thus NOT made more widely available. Though a small number may migrate to the supply side (e.g., as implementation consultants), we do not see the emergence of a stream of hybrid experts (that we may see for example around commercial enterprise system provision). Other hospitals and trusts may therefore be forced to learn the same lessons from scratch.

3. In the USA, in contrast, HEPMA implementation is often combined with efforts to standardise care regimes.