Relations between ICT Architectures and Organizational Complexity and Risk

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April Lyons
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1 Relations between ICT Architectures and Organizational Complexity and Risk Inter-institutional Information Exchange in Health Care in Norway Ole Hanseth Department of Informatics University of Oslo, Norway

2 The beginning 1987: Fürst s lab report transfer solution 1988: Telenor (Telemedicine in Northern Norway) Lab report transfer solutions Standardizing Statskonsult s Infrastructure programme: EDI Physicians invoices CEN TC/251, KITH Consensus: EDI

3 90-ies: The continuation Lab reports & orders, prescriptions, physicians and outpatient clinics invoices, admission and discharge letters,.. 00-ies: Lab reports & orders, prescriptions, physicians and outpatient clinics invoices, admission and discharge letters,.. ELIN projects The message effort (meldingsløftet) eprescription Status: Modest successes, coordination problems, always someone not doing as promised

4 The EDI Paradigm Information flow ICT architecture Project organization GP offices Hospitals GPs EPR Hospital systems Vendors of GPs EPR Vendors of hospital syst. NAV Pharmacies Labs NAV systems Pharmacy systems Lab systems NAV s dev. org. Vendor of the Pharmacies system Vendors of Lab systems

5 eprescription MyPresciptions Information on medicins in use eprescriptions information Prescription information EPJ- Systems Prescription Recall Hand-over message Deleted prescription Reply from Medicine Agency eprescriptions Exchange Request for expedition Prescription information Hand-over message Pharmacysystem Consent information Reference number Request for assessment by Gvt Medicine Agency Application NAV Prescription and expedition information Notification Application to of Medicine Agency hand-over Reply on application GP information Refund request Refunds and control (NAV) Reply on Refund request FEST (Gvt Medicine Agency) Application (Gvt Medicine Agency) Prescription and expedition information

6 A few other projects Fürst Lab report transfer solution, 1987, 3 man weeks + 1 evening Lab ordering solution Northern Norwegian Health Care Well/Dips Interactor Interactive admission letters BlueFox

7 An alternative architecture GP office GP s computer GP s EPR system GP GP computer Client module Communication system/network Server module Project org. Lab/hospital Lab system Lab/hospital ICT architecture Project organization

8 Summary Care Record Systems Scotland: 3 MGBP (4M Euros, 4 M USD) Denmark: Official, top-down 10 M Euros, Faded out after about 4 years, officially cancelled after 8 Unofficial, bottom-up Great success Norway (eprescription) UK 500 MNOK, currently piloted in one GP office Started 2004, early adoption 2007, further deployment is frozen Spent 240 MGBP

9 Institutional Interface Architecture Complex technical solution Inflexible, cannot be maintained Very complex project organization Top-down Escalating complexity (destabilizing) Stabilizing (freezing) user practices Failure Conclusion Application Service Provider Architecture Simple technical solution Flexible, easy to maintain Very simple project organization Bottom-up, evolutionary Stable complexity Destabilizing user practices (stimulating organizational innovation) Success

10 What needs to be done Bring learning (and research) into the projects Start working on the design of a SOA for national infrastructures (eprescription, Summary Care Records and other solutions supporting (necessary for improved) collaboration (samhandling) And for Primary Care

11 Top-down All stakeholders involved Each has separate requirements The more stakeholders involved, the more new requirements will be generated Each change: all stakeholders have their requirements.. Aims at stability generates destabilizing processes

12 Thank you!

Building for the Next Generation: Practical Challenges for Platformization at a Norwegian Hospital

Building for the Next Generation: Practical Challenges for Platformization at a Norwegian Hospital Troels Mønsted, Kristoffer Fossum University of Oslo, Norway monsted@ifi.uio.no, kristofo@student.matnat.uio.no