Abstract
For decades, the notion of eHealth has carried great promise of improved efficiency and quality of care through information technology (IT)-based capabilities. Along these lines, several strategies have been put into place to implement eHealth in practice. However, a recurring challenge is how eHealth technologies have proven considerably more complex and time-consuming to implement than initially anticipated. This is the starting point for the highly knowledgeable book ‘Information Infrastructures within European Health Care: Working with the Installed Base’ that deals with the on-going challenges and strategies of implementing eHealth technologies in real clinical practice across Europe.
With a broad approach to the notion of eHealth, the editors include technologies such as Electronic Health Record systems (EHRs), which play a central role in health institutions, picture archiving and communication systems (PACS), radiology information systems (RIS), computerised physician order entry (CPOE), electronic medication management systems (EMMS) and laboratory systems (LAB). A common pattern is that many of these technologies frequently have faced serious problems when confronted with real practice.
The book is organised in three sections: Part I ‘Information Infrastructures in Healthcare’ presents the empirical domain of the book, the context of eHealth infrastructures, the core theoretical concepts, and the cross-case analysis of the cases. Part II ‘E-Prescription Infrastructures’ contains six chapters analysing various European experiences with putting in place eHealth infrastructures. The empirical studies on e-prescription are from Spain, Norway, Greece, the United Kingdom and Germany. Part III ‘Governmental Patient-Oriented eHealth Infrastructures’ contains five empirical chapters on governmental platforms for patient-oriented eHealth services from Spain, Norway, Denmark, Sweden and Italy. The organisation of the book is excellent, as the conceptual backbone of the book on Information Infrastructure is assembled in part I together with the associated cross-case analysis. This increases the readability of the book with a clear focus on the conceptual underpinnings and analysis.
Conceptually, the authors apply an information infrastructure perspective, which has proven very useful for analysing the emergence of large-scale interconnected systems. While such a perspective is well rehearsed in the IS research literature, the authors take a refreshingly deep dive into one of the central elements of an information infrastructure, namely, the installed base. Both physically and conceptually, the installed base represents the existing technologies and practices. The authors argue that we always need to take the installed base into account in all eHealth implementation processes for ensuring a successful organisational outcome. This is very interesting due to the stark contrast of such a strategy with prevalent managerial strategies in many eHealth projects, recognised by high ambitions of sweeping change and replacement of out-of-date technology. The authors elaborate how further evolution of the installed base creates a paradox as it entails building on the installed base and transforming it at the same time – that is, adapting too much to the existing installed base may strengthen its irreversibility and hinder change, while disregarding it may limit the initial utility of any initiative and impede growth. Actually, finding the right balance between stability and change should thus be a key question in eHealth implementation projects.
The empirical cases are carefully selected across European healthcare. They centre on two topics: (a) E-prescription solutions that support the electronic flow of information related to prescribed medications, and (b) the development of patient-oriented eHealth services. The stringent selection of empirical cases creates coherency both among the various cases and within the book as a whole. As such, the empirical cases lay the groundwork for a coherent cross-case analysis that is informative, innovative and convincing. Another intriguing aspect is that the broad selection of empirical cases across Europe demonstrates how qualitative methods – frequently associated with local studies – can be very useful for comparable studies on a large scale as well.
With this book, the editors have done an eminent job of selecting a highly competent author team from different countries across Europe, each highlighting the topic of eHealth from a representative European country. In turn, the authors have exploited the heterogeneous empirical narratives as a foundation for targeted (and homogeneous) conceptual analysis of the installed base concept from the information infrastructure field. Clearly, the book should be mandatory reading for scholars and students in the information systems field as well as for policymakers across Europe.