Information Systems Frontiers

, Volume 14, Issue 1, pp 19–42 | Cite as

Ski hill injuries and ghost charts: Socio-technical issues in achieving e-Health interoperability across jurisdictions

  • Ellen Balka
  • Sandra Whitehouse
  • Shannon T. Coates
  • Dug Andrusiek


This paper looks at the challenges associated with consolidating and leveraging patient information recorded at various points in a distributed, multi-jurisdictional health care system. We draw on insights from two ethnographic case studies to illuminate varied issues related to interoperability of information management systems. Our first case study is an investigation of duplicate medical charts which exist in several ambulatory care clinics located on the same campus at an acute care hospital. The second case study is an ongoing exploratory project intended to develop an understanding of information collection, storage and handover procedures in the pre-hospital care chain, a health care domain that includes varied actors and organizations with different information needs. Whereas findings from our case studies show that achievement of interoperability will be difficult, our analysis suggests ways to begin to overcome these challenges.


Socio-technical issues Interoperability Handovers in care Data handovers Ghost charts Shadow records Duplicate medical charts Electronic health records Interoperability 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Ellen Balka
    • 1
  • Sandra Whitehouse
    • 2
  • Shannon T. Coates
    • 3
  • Dug Andrusiek
    • 4
  1. 1.School of CommunicationSimon Fraser UniversityBurnabyCanada
  2. 2.Department of PediatricsBC Children’s HospitalVancouverCanada
  3. 3.School of Interactive Arts + Technology (SIAT)Simon Fraser University SurreySurreyCanada
  4. 4.School of Population and Public Health, Faculty of MedicineUniversity of British ColumbiaVancouverCanada

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