Computer Supported Cooperative Work (CSCW)

, Volume 12, Issue 1, pp 71–95 | Cite as

A Patchwork Planet Integration and Cooperation in Hospitals

  • Gunnar Ellingsen
  • Eric Monteiro


The `seamless' integration of a collectionof information systems has been recognised asvital in promoting and realising thecollaborative aspects of work. This emphasis onthe collaborative role of integrationsupplements other studies in CSCW focusing onmore singular tools for collaboration.Empirically, we analyse the design and use ofan electronic patient record system (EPR) inlarge hospitals in Norway. We discuss theconditions for and types of integration of EPRwith the host of related information systems inhospitals. We formulate design principles forthe integration of collaborative informationsystems based on a pragmatic study of theproductive role of redundant, fragmented andambiguous information.

ambiguity collaborative work practices electronic patient records (EPR) fragmentation hospital information systems integration redundancy 


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  1. Atkinson, Paul (1995): Medical Talk and Medical Work. Sage Publications Ltd.Google Scholar
  2. Atkinson, C.J. and V.J. Peel (1998): Transforming a Hospital Through Growing, Not Building an Electronic Patient Record System. Methods of Information in Medicine, vol. 37, pp. 285–293.Google Scholar
  3. Barley, Steve (1986): Technology as an Occasion for Structuring: Evidence from Observation of CT Scanners and the Social Order of Radiology Departments. Administrative Science Quarterly, vol. 31, pp. 78–108.Google Scholar
  4. Beck, Ulrich (1992): Risk Society: Towards a New Modernity. London: Sage.Google Scholar
  5. Berg, Marc (1998): Medical Work and the Computer Based Patient Record: A Sociological Perspective. Methods of Information in Medicine, vol. 38, pp. 294–301.Google Scholar
  6. Berg, Marc (1999): Accumulating and Coordinating: Occasions for Information Technologies in Medical Work. Computer Supported Cooperative Work, vol. 8, pp. 373–401.Google Scholar
  7. Berg, Marc (2000): Lessons from a Dinosaur: Mediating IS Research Through an Analysis of the Medical Record. Paper presented at IFIP WG 8.2 Working Conference 2000: IS 2000: The Social and Organizational Perspective on Research and Practice in Information Technology.Google Scholar
  8. Berg, Marc and Bowker Geoffrey (1997): The Multiple Bodies of the Medical Record: Toward a Sociology of an Artifact. The Sociological Quarterly, vol. 38, no. 3, pp. 513–537.Google Scholar
  9. Blume, S. Stuart (1991): Insight and Industry: On the Dynamics of Technological Change in Medicine. Cambridge, MA: MIT Press.Google Scholar
  10. Boland, Richard and Tenkasi Ramkrishnan (1995): Perspective Making and Perspective Taking in Communities of Knowing. Organization Science, vol. 6, no. 4, pp. 350–372.Google Scholar
  11. Bowker, Geoffrey and Star Susan Leigh (1999): Sorting Things Out: Classification and its Consequences. Cambridge, MA: MIT Press.Google Scholar
  12. Bowker, G., S. Timmermans and S.L. Star (1995): Infrastructure and Organizational Transformation: Classifying Nurses' Work. In W. Orlikowski, G. Walsham, M.R. Jones and J.I. DeGross (eds.): Information Technology and Changes in Organizational Work. London: Chapman & Hall.Google Scholar
  13. Davenport, Thomas (1998): Putting the Enterprise into the Enterprise System. Harvard Business Review, July–August, pp. 120–131.Google Scholar
  14. De G. Moore (1993): Standardisation in Health Care Informatics and Telematics in Europe: CEN 251 Activities. In De Moore, C. McDonald and J. Noothoven van Goor (eds.): Progress in Standardization in Health Care Informatics. Amsterdam: IOS Press.Google Scholar
  15. Dick, R., E.B. Steen and D. Detmer (eds.) (1997): The Computer-based Patient Record: An Essential Technology for Health Care. Washington, DC: National Academy Press.Google Scholar
  16. Ellingsen, G. and E. Monteiro (2001): Big is Beautiful: Electronic Patient Records in Large Hospitals in Norway 1980s–2001. In Proc. 24th Information Systems Research Seminar in Scandinavia (IRIS).Google Scholar
  17. Gasser, Les (1986): The Integration of Computing and Routine Work. ACM Trans. on Office Information Systems, vol. 4, no. 3, pp. 205–225.Google Scholar
  18. Grimson, J.,W. Grimson and W. Hasselbring (2000): The SI Challenge in Health Care. Communications of the ACM, vol. 43, pp. 48–55.Google Scholar
  19. Grimson J., W. Grimson, D. Berry, G. Stephen, E. Felton, D. Kalra, P. Toussaint and O.W. Weier (1998): A CORBA-Based Integration of Distributed Electronic Healthcare Records Using the Synapses Approach. IEEE Transactions on Information Technology in Biomedicine, vol. 2, no. 3, pp. 124–138.Google Scholar
  20. Hanseth, O. and N. Lundberg (2001): DesigningWork Oriented Infrastructures. Computer Supported Cooperative Work, vol. 10, pp. 347–372.Google Scholar
  21. Harper, R.H.R., K.P.A. O'Hara, A.J. Sellen and D.J.R. Duthie (1997): Toward the Paperless Hospital? British Journal of Anaesthesia, vol. 78, pp. 762–767.Google Scholar
  22. Hartswood, M., R. Procter, M. Rouncefield and M. Sharpe (2002): Making a Case in Medical Work: Implications for the Electronic Medical Record (forthcoming in Computer Supported Cooperative Work).Google Scholar
  23. Hasselbring, W. (2000): Information System Integration. Communications of the ACM, vol. 43, no. 6, pp. 32–38.Google Scholar
  24. Hutchins, Edwin (1994): Cognition in the Wild. MIT Press.Google Scholar
  25. Klein, H. and M. Myers (1999): A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Quarterly, vol. 23, no. 1, pp. 67–94.Google Scholar
  26. Knorr-Cetina, Karin (1999): Epistemic Cultures: How the Sciences Make Knowledge. Harvard University Press.Google Scholar
  27. Kohane, I.S., P. Greenspun, J. Fackler, C. Cimino and P. Szolovits (1996): Building National Electronic Medical Record Systems via the World Wide Web. Journal of the American Medical Informatics Association, vol. 3, no. 3, pp. 191–207.Google Scholar
  28. Kumar, K. and J. van Hillegersberg (2000): ERP Experiences and Evolution. Communications of the ACM, vol. 43, no. 4, pp. 23–26.Google Scholar
  29. Kushniruk, A.W., D.R. Kaufman, V.L. Patel, Y. Levesque and P. Lottin (1996): Assessment of a Computerized Patient Record System: A Cognitive Approach to Evaluating Medical Technology, M.D. computing, vol. 13, no. 5, pp. 406–415.Google Scholar
  30. Latour, Bruno (1999): Pandora's Hope: Essays on the Reality of Science Studies. Harvard University Press.Google Scholar
  31. Levitt, I. John (1994): Why Physicians Continue to Reject the Computerized Medical Record. Minnesota Medicine (August), vol. 77, pp. 17–21.Google Scholar
  32. Luff, P., C. Heath and D. Greatbatch (1992): Tasks-in-interaction: Paper and Screen Based Documentation in Collaborative Activity. ACM Conference Proceedings of Series CSCW '92: Computer-Supported Cooperative Work. ACM Press.Google Scholar
  33. Lærum, H., G. Ellingsen and A. Faxvaag (2001): A Survey of Physicians' Use of Electronic Medical Records Systems in Hospitals. British Medical Journal, vol. 323, pp. 1344–1348.Google Scholar
  34. Massaro, A. Thomas (1993): Introducing Physician Order Entry at a Major Academic Medical Center: Impact on Organizational Culture and Behavior. Academic Medicine, vol. 68, pp. 20–25.Google Scholar
  35. McNurlin, C. Barbara and Sprague H. Ralph (eds.) (1997): Information Systems Management in Practice. Prentice Hall.Google Scholar
  36. Nonaka, I. and H. Takeuchi (1998): A Theory of the Firm's Knowledge-creating Dynamics. In A.D. Chandler Jr, P. Hagstrøm and Ø. Sølvell (eds.): The Dynamic Firm. The Role of Technology, Strategy, Organization and Regions. Oxford Univ. Press.Google Scholar
  37. Nygren, E. and P. Henriksson (1992): Reading the Medical Record. Analysis of Physicians' Ways of Reading the Medical Record. Computer Methods and Programs in Medicine, vol. 39, pp. 1–12.Google Scholar
  38. Perrow, C. (1984): Normal Accidents: Living with High-risk Technologies. New York: Basic Books.Google Scholar
  39. Pinch, T. and W. Bijker (1989): The Social Construction of Facts and Artifacts: or How the Sociology of Science and the Sociology of Technology Might Benefit from Each Other. In W. Bijker, T.P. Hughes and T. Pinch (eds): The Social Construction of Technological Systems. MIT Press, pp. 17–50.Google Scholar
  40. prENV13606 1–4 (1999): CEN/TC 251 prENV 13606 1–4: Health informatics — Electronic healthcare record communication.Google Scholar
  41. Safran, D.Z., D.Z. Sands and D.M. Rind (1999): Online Medical Records: A Decade of Experience. Methods of Information in Medicine, vol. 38, pp. 308–312.Google Scholar
  42. Sands, D.Z., H. Libman and C. Safran (1995): Meeting Information Needs: Analysis of Clinicians' Use of an HIV Database through an Electronic Medical Record. In R.A. Greenes et al. (eds): MEDINFO 95 Proceedings, pp. 323–326.Google Scholar
  43. Schmidt, K. and L. Bannon (1992): Taking CSCW Weriously. Supporting Articulation Work, Computer Supported Cooperative Work, vol. 1, pp. 7–40.Google Scholar
  44. Sheth, A.P. and J.A. Larson (1990): Federated Database Systems for Managing Distributed, Heterogeneous, and Autonomous Databases. ACM Computing Surveys, vol. 22, no. 3, pp. 183–236.Google Scholar
  45. Straus, A., S. Fagerhaugh, B. Suczek and C. Wiener (1985): Social Organization of Medical Work. Chicago: The University of Chicago Press.Google Scholar
  46. Suchman, L. (1987): Plans and Situated Action. Cambridge University Press.Google Scholar
  47. Suchman, L. (1993): Technologies of Accountability. In G. Button (ed.): Technology in Working Order. London and New York: Routledge.Google Scholar
  48. Symon, G., K. Long and J. Ellis (1996): The Coordination of Work Activities: Cooperation and Conflict in a Hospital Context. Computer Supported Cooperative Work, vol. 5, pp. 1–21.Google Scholar
  49. Szolovits, P. et al. (1995): Multiplatform Internet Access to Multimedia EMRS: Excerpts from the Original Collaborative Proposal to the National Library of Medicine. The W3 EMRS project, Scholar
  50. Szyperski, C. (1999): Component Software: Beyond Object-Oriented Programming. ACM PressNew York: Addison-Wesley.Google Scholar
  51. Timmermans, S. and M. Berg (1997): Standardization in Action: Achieving Local Universality Through Medical Protocols. Social Studies of Science, vol. 27, pp. 273–305.Google Scholar
  52. Unified requirement specification (1996): Unified requirement specification between SNI A/S and the University hospitals in Norway, 9 May 1996.Google Scholar
  53. W3 EMRS project (1995): Google Scholar
  54. Walsham, G. (1993): Interpreting Information Systems in Organizations. John Wiley.Google Scholar
  55. Workgroup II (1999):Medakis description of solutions — workgroup II, 20 January 1999, version 0.7, pp. 1–21.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Gunnar Ellingsen
    • 1
  • Eric Monteiro
    • 2
  1. 1.Dept. of Computer and Information ScienceNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Dept. of Computer and Information ScienceNorwegian University of Science and TechnologyTrondheimNorway (E-mail

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