Academic journal article Journal of the Association for Information Systems

Exploring the Formation of a Healthcare Information Infrastructure: Hierarchy or Meshwork?

Academic journal article Journal of the Association for Information Systems

Exploring the Formation of a Healthcare Information Infrastructure: Hierarchy or Meshwork?

Article excerpt


The digitalization of economic and social activity has brought information infrastructures (IIs) to the forefront of research. This paper studies II formation processes and their outcomes; namely, II architecture and distribution of control rights. We conduct an in-depth exploratory case study of an electronic prescription II and report on two formation processes: stratification and meshworking. The stratification process in our case study involved classifying the IIs' diverse socio-technical components into homogeneous groups and consolidating them into a coherent hierarchical structure that standardized the components' behavior. The outcome of this stratification was a dual and hierarchical architecture and a fairly centralized locus of control. The meshworking process, by contrast, assembled heterogeneous components without homogenizing them; the components were distributed in a way that enabled them to self-organize. The outcome of this meshworking process was a modular architecture that decoupled the central nodes from the users' installed base and a more decentralized structure. Consequently, the final II architecture was a hybrid offering both centralized control and autonomy of the parts. Our research further illustrates how this architecture then influenced the project's complexity and the actors' position in the sector. We build our contribution on extant II research.

Keywords: Information Infrastructure, Architecture, Formation, Meshwork, Hierarchy, Emergence, Design, Healthcare, Control.

1. Introduction

The notion of information or digital infrastructure (II), as a perspective on and a new category of IT artifact, has gained much attention following the work of Geoffrey C. Bowker, Claudio Ciborra, Ole Hanseth, Eric Monteiro, Susan Leigh Star, and others in the 1990s. An II is a shared, evolving, open, heterogeneous large-scale socio-technical system comprising an installed base of IT capabilities and their corresponding user, operations, and design communities (Hanseth & Lyytinen, 2010; Tilson, Lyytinen, & Sorensen, 2010). According to these authors, one core trait that IIs share is that they do not grow exnovo; they wrestle with the inertia of the existing installed base of technical systems, organizational structures, practices, user preferences, and behavioral patterns; hence, IIs need to be designed for backward compatibility (Ciborra, 2000; Hanseth & Lyytinen, 2010; Star & Ruhleder, 1996).

Acknowledging this central role of the installed base, existing II literature has converged to rep ort several strategies that have proven to be effective in resolving tensions between the design and user communities, which has ultimately led to IIs' successful implementation and evolution. These strategies address diverse challenges faced by IIs ; for instance, bootstrapping (Hanseth & Aanestad, 2003; Hanseth & Lyytinen, 2010), adaptation (Hanseth & Lyytinen, 2010), mobilization (Aanestad & Jensen, 2011), generativity (Bygstad, 2010; Grisot & Vassilakopoulo, 2013), flexibility (Braa, Hanseth, Heywood, Mohammed, & Shaw, 2007; Hanseth, Monteiro, & Hatling, 1996), and interoperability (Ure et al., 2009). These strategies are abstractions that take the form of descriptive regularities (process patterns), self -reinforcing mechanisms that produce observable eve nts, and meanings that capture the researchers' interpretations of events. Moreover, these implementation strategies are related with the II architecture resulting from the design process. For instance, Aanestad and Jensen (2011) illustrate in one case how a design based on a modular architecture minimized the challenges of stakeholder mobilization because it "did not require every potential stakeholder's participation, investment and commitment upfront" (p. 173). Braa et al. (2007) suggest a strategy to develop flexible standards that improve healthcare IIs in developing countries through vertical and horizontal modularization. …

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