Strategies for Building eHealth Infrastructures

Excerpt

This chapter presents a cross-case analysis of the eleven empirical chapters of the book. We discuss the six e-prescription cases and the five patient-oriented eHealth cases in terms of the initiatives’ scope, starting point, and motivation, and then, we turn to observed strategies towards the installed base for the two types of infrastructures. E-prescription is relatively well-defined in terms of functionality and there are clear interdependencies with existing healthcare applications (e.g. Electronic Health Record systems and Pharmacy systems) as well as with established practices for prescribing, dispensing and reimbursement of drugs. The e-prescription cases illustrate a variety of approaches towards the installed base, and we identify what we call installed base-friendly, installed base-hostile and installed base-ignorant approaches. Initiatives to build patient-oriented eHealth platforms are typically more open in scope and are realized through exploratory processes that define the linkages to existing systems and practices. The cases of patient-orient eHealth initiatives illustrate a variety of approaches for the coordination of multiple involved actors, for handling technical heterogeneity, for addressing uncertainty and for supporting transformations. We conclude by pointing to the importance of taking an installed base perspective. This perspective brings into attention how existing technologies, institutions and practices matter when putting in place eHealth infrastructures.