Tensions and Coordination Mechanisms in National Healthcare IT Initiatives

Seminar abstract

The ability to share health data is widely acknowledged as necessary for achieving integrated, better quality care and more efficient services. To this end many countries have embarked on national health IT initiatives, such as implementing electronic health records.

The literature identifies different problems and tensions arising in such initiatives. It also proposes strategies for resolving them, mostly in relation to architectural choices and governance models, as well as institutional forces and stakeholder roles and perceptions.

Whilst this literature has produced wealth of insights, to our knowledge there has been less focus on coordination of the healthcare ecosystem in which such initiatives take place. Such coordination is particularly challenging because of the large number of heterogeneous and often powerful actors, regulatory hurdles, diverse practices, and a large portfolio of IT systems (often hundreds if not thousands of systems in each individual organization) that are maintained through complex collaborative arrangements.

Drawing on the literature on national health IT initiatives and coordination in health IT ecosystems, and applying perspective of dialectical tensions i.e., tensions between underlying contradictory forces, this study addresses the following questions:

1. What are the dialectic tensions underpinning national health IT initiatives to integrate healthcare?
2. How do the coordination mechanisms employed affect those tensions?

To address those questions, we conduct a qualitative case study of a current national initiative in England to implement integrated digital care records.

The approach taken in England combines national government direction with local autonomy. Such an approach has been described in the literature as middle-out and proposed as a solution to problems with top-down and bottom-up implementations. Although it has been adopted in several countries little details have been provided into how it might be carried out. Hence, our study delivers insights on this topic and makes contributions to the literatures on national health IT initiatives and coordination of ecosystems by explicating tensions those initiatives give rise to, and by analysing coordination efforts to address them. Our paper depicts how coordination is undertaken at national and regional levels, and how it simultaneously helps to address existing tensions and creates new ones.

Booking

This seminar is free to attend with no need to book in advance.

We warmly encourage you to join in with you friends, colleagues and classmates.

Join this seminar online on Wednesday 30 June 2021 at 1pm.

Speaker bio

Ela Klecun is an assistant professor in Information Systems at the London School of Economics and Political Science. She received a BSc in Computing from Guildhall University, and a Master degree and a PhD in Information Systems from the LSE.

Her research is oriented towards developing a greater understanding of the way information and communication technologies (ICT) shape institutions, work practices and experiences of professional groups and individual people.

In pursuit of this goal she researched policy, strategy and deployment of ICT in healthcare, from nation-wide infrastructures, such as shared electronic health records, to medical apps. She also investigated the skills and dispositions required to pursue ICT-enabled activities and the consequences of digital exclusion. Her research has been funded by various UK research councils.

She published in major information systems, organization and medical journals, such as JAIS, JIT, EJIS, Organization, and BMJ.