Seamless Integration: Standardisation across Multiple Local Settings

Abstract

The pressure towards tighter or “seamless” integration of health information systems is a recurring issue with both practical and analytical relevance. It taps into a discourse in the IS literature in general and organisation and management science in particular. Unfortunately, the prevailing perception of integration in the IS literature is as a predominantly technical issue. The CSCW literature, however, is attentive to the socio-technical aspects of integration. Building on this – but supplemented with recent elaborations in science studies – we aim at exploring the unintended consequences of information systems integration. A user-led perspective implies emphasising the tailoring to local needs based on in-depth studies of the micro practices. We argue, however, that the condition for such an approach is radically undermined by politically motivated, regional changes towards integration with implicated standardisation. Enforcing order in the form of standards across multiple local settings, seemingly a prerequisite for tight integration, simultaneously produces disorder or additional work in other locations for other users. Empirically, our study is based on a large, ongoing integration effort at the University hospital of Northern Norway, specifically studying work practices and perceptions across multiple laboratories.