Academic journal article Journal of the Association for Information Systems

Configurable Politics and Asymmetric Integration: Health E-Infrastructures in India*

Academic journal article Journal of the Association for Information Systems

Configurable Politics and Asymmetric Integration: Health E-Infrastructures in India*

Article excerpt


Information Infrastructures typically evolve in an incremental fashion, through partly planned and unplanned processes. A significant mechanism of growth is when previously unconnected systems are integrated, facilitating the transition from networking to inter-networking. Conversely, failure to integrate systems contributes to the lack of evolution of the infrastructure. Integration seems crucial for evolving infrastructures; however, there is little consensus on what it entails, as can be seen when different connotations of 'integration" are unpacked. In contrast to the dominant view of integration as a largely technical concern, our focus is on how political and institutional interests are embedded in efforts to achieve integration. More specifically, we explore strategies for institutional integration that take into account uneven distribution of political influence. The paper builds on empirical material from our ongoing (2001 - 2008) involvement with the problem of fragmented information systems in the health care sector in India. The case is seen from the perspective of one small actor offering free, open-source software that is already being used in several other developing countries. Choosing to focus on a small actor highlights the asymmetric power relations among the actors; our actor has no other option than to seek to align with bigger and more influential actors. We analyse the strategies, the configurable politics, and the outcomes of the distinct configurations that emerge from this form of asymmetric integration.

Keywords: integration, health care information systems, HISP, India, politics

1. Introduction

The growth trajectories of stand-alone technological artefacts differ significantly from large-scale, inter-connected - i.e. infrastructure - technology. The field of large technical systems consists of historical accounts of the development of infrastructures including railroads, sewage systems, and highways (Summerton 1994). An exemplary case is Hughes' (1983) description of the establishment of electrical power supply systems on the east coast of the US in the latter half of the 18th century. Predominantly, this field has emphasised evolutionary, path-dependent change processes that ultimately lead to stabilisation. ICT-based infrastructure technology, e-Infrastructure, exhibits characteristics similar to those of other infrastructures, e.g., of path-dependencies (Hanseth et al. 2001, 2006, Kallinikos 2004). Far less attention is devoted to (more) radical change (but see Egyedi and Verwater-Lukszo 2005; Hanseth 2001, and Geels 2007 for exceptions). Often these radical change processes arise due to political events, as illustrated by Silva's (2002) description of how post-war crisis in Guatamala paved the road for the delegation of responsibility to consultants for the design of information systems in hospitals.

A characteristic, arguably defining, aspect of e-Infrastructures is their configurability - both technical (Fleck 1988, 1994, Williams, Stuart and Slack 2005) and interpretive (Orlikowski 1992) which inscribes in them the potential to evolve (or not) over time. These e-Infrastructures, by their very definition, need to adapt, interconnect, co-evolve - in short, integrate with other systems - in ways that are poorly understood in research, in terms of patterns of development, innovation, and use. Strong business trends favor ambitious, generic software packages (e.g., enterprise resource planning systems, content management publishing systems, or customer relationship management systems) that presuppose the possibility of extensive local adaptation in the form of configuration through calibration of various technical parameters (Pollock et al. 2007). Likewise, the wrapping of complementary components or applications into portfolios or services is propelled by the apparent ease of integration of ICT artefacts (as claimed especially by ICT vendors).

IS literature over the last two decades has emphasized the social and political construction and use of IS applications (Orlikowski 2000; Williams et al. …

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