Clinical Nursing Terminology as Information Infrastructure : a socio-technical approach towards process oriented systems

Abstract

Abstract This work deals with a socio-technical approach towards the implementation and use of ICT systems in health care. I have highlighted important initiatives that support the development of process oriented EPR systems in Norway through interpretive case studies with focus on standards in nursing and the secondary use of information. In short, information infrastructure has been used as a theoretical lens to investigate work practices in heterogeneous hospital departments, and with a focus on the technical and semantic interoperability of importance to the continuity of care. The results may be a small step towards process oriented EPR systems, but they contain theoretical and practical implications that support and constitute my work using information infrastructure as a theoretical lens. The main contribution is the empirical investigation of efforts made in Norway to support the growth of process oriented EPR systems to secure the continuity of patient care with focus on semantic and technological interoperability. The overall message is that nursing as a profession and nurses’ work practice constitute the most interesting area for investigating process oriented EPR systems in Norway, where data has been categorized to a certain degree and where terminology standards have been in practical use over time. This reflects that the future accomplishments in the development of process oriented systems in Norwegian healthcare should be built on fieldwork experience from investigating nursing practice in relation to the use of information systems. The thesis has pinpointed some theoretical implications and considerations with focus on IS, STS, and CSCW concepts that serve to explain changes of information infrastructure development with focus on work process oriented standards, and human relations. The concepts have further been contextualized in a theoretical as well as a practical/methodical sense in order to indicate their contributions. Concepts such as universal locality and collective capability have pinpointed how manual work, and collaborative work among hospital workers solve problems related to semantic interoperability, which again contributes to our knowledge about the amount of work that stable semantic interoperability challenges. For the main theoretical aim, the thesis contributes to the general idea of information infrastructure as a framework for IS development with focus on work processes and clinical terminologies. While scholars of the IS community work in Scandinavia has focused on II in a strategically and organizational perspective (see, for instance, Hanseth and Monteiro 1997; Monteiro and Hanseth 1995; Hanseth, 2000; Bowker and Star, 1999; Sahay et al. 2009), this work sheds light on the work processes that go into information infrastructure. Further, Bowker and Star (1999) discuss and put terminologies forward as information infrastructure, focusing on organizational implications. Clinical terminologies are elaborated on as information infrastructure, both as a working infrastructure to support daily routines and as a reference terminology to create semantic interoperability. Unlike in Bowker and Star, the focus on terminology as infrastructure is discussed and developed around work process oriented standards and human relations.