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Infrastructuring in Healthcare through the OpenEHR Architecture

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Abstract

In Norway, a national initiative is currently aiming at standardising the electronic patient record (EPR) content based on an openEHR framework. The openEHR architecture, offers users the capability to conduct standardisation and structuration of the EPR content in a distributed manner, through an internet-based tool. Systems based on this architecture, is expected to ensure universal (also internationally) interoperability among all forms of electronic data. A crude estimate is that it is necessary to define somewhere between 1000 and 2000 standardised elements or clinical concepts (so-called archetypes), to constitute a functioning EPR system. Altogether, the collection of defined archetypes constitutes a backbone of an interoperable EPR system lending on the openEHR architecture. We conceptualize the agreed-upon archetypes as a large-scale information infrastructure, and the process of developing the archetypes as a infrastructuring effort. With this as a backdrop, we focus on the following research question: What are the challenges of infrastructuring in a large-scale user-driven standardisation process in healthcare? This question is operationalized into three sub-questions: First, how are the openEHR-based archetypes standardised in practice? Second, what is the role of daily clinical practice, and existing systems in the process of developing archetypes? Third, how may related, but supposedly independent infrastructuring projects shape each other’s progress? We contribute with insight into how power relations and politics shape the infrastructuring process. Empirically, we have studied the formative process of establishing a national information infrastructure based on the openEHR approach in the period 2012–2016 in Norway.

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Notes

  1. National ICT is a separate health trust responsible for coordinating ICT-related initiatives in the Norwegian specialized health care services (National ICT 2011). The four health authorities in Norway provide the mandate for National ICT. National ICT is a central actor in realizing national ICT efforts and strategies in Norway.

  2. The National Centre for Telemedicine and e-health (NST), now reorganized as the National Centre for E-health Research, was a multidisciplinary research centre where researchers with different backgrounds such as health care, computer science, and sociology worked together in projects with advisors from equally divergent backgrounds.

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Authors and Affiliations

  1. Telemedicine and E-health Research Group, The Arctic University of Norway, Tromsø, Norway

    Gro-Hilde Ulriksen, Rune Pedersen & Gunnar Ellingsen

  2. Norwegian Centre for E-health Research, University Hospital of North Norway, Sykehusveien 23, 9019, Tromsø, Norway

    Gro-Hilde Ulriksen, Rune Pedersen & Gunnar Ellingsen

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  1. Gro-Hilde Ulriksen
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  2. Rune Pedersen
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  3. Gunnar Ellingsen
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Correspondence to Gro-Hilde Ulriksen.

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Ulriksen, GH., Pedersen, R. & Ellingsen, G. Infrastructuring in Healthcare through the OpenEHR Architecture. Comput Supported Coop Work 26, 33–69 (2017). https://doi.org/10.1007/s10606-017-9269-x

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