Responsive Architectures for Innovation in Collaborative Healthcare Services

Through new web-based and mobile technologies the healthcare sector can offer its services in new ways that allows the patient a more central role. However, this is not always easy to do. To give patient access to retrieve or enter information in the hospitals' IT systems may conflict with security policies and legislation. When patients initiate the communication based on their own needs, this may not match well with the way hospitals usually organize their work, with pre-planned patient encounters. In addition, the new types of services and communication modalities may not be covered by the reimbursement system. In this project we study the challenges and possibilities that these technologies bring up when they are utilized together with an existing information infrastructure in the health sector. We apply a cross-disciplinary approach from the research domains of Information Systems, Organizational Theory and Innovation Studies. We conduct a number of qualitative case studies of ongoing projects. The aim it to contribute to the understanding of the requirements for exploiting the potential transformative potentials and benefits of these technologies. At Oslo University Hospital we follow the development of MyRecord. This is a communication tool that offers patient a possibility to communicate with the hospitals around their own treatment as well as access to relevant information (both general and personal). Our studies of the development trajectory illuminate how such solution concepts emerge in ways that both draw on existing structures and change them. We also follow the deployment of MyRecord at Sunnaas Rehabilitation hospital, where it is used to establish other service models connected to the hospital's telemedical activities. Another case is new services where the collaboration between municipality and hospital is re-organized in a patient-centric way. Oslo University hospital and Oslo municipality collaborate in the "Collaboration Arena Aker" to develop new models for preventive treatment of non-communicable diseases such as COPD and diabetes, as well as rehabilitation. Such patient-centered services pose challenges to the existing patient trajectories and collaboration modes, where also organizational, institutional, regulatory and technical contingencies shape the outcome. The organizational aspects of innovation and change processes are also theme in our research collaboration with the "Outpatient clinic for ideas" at Oslo University Hospital, with a focus on modes of documentation and evaluation. In a Master project a prototype for a personal archiving and sharing solution where patients can upload their health information and share it with whomever they may wish. This prototype has generated insights into what functionality potential users wishes to have, as well as into unclarities related to the existing regulatory framework for mobile platforms and cloud solutions. We also study the government-initiated initiatives to establish patient-centered services and solutions, e.g. in the platform "helsenorge.no". Here we follow the development process of the solutions for digital dialogue between patients and the health care sector. Specifically, through the project "Digital Dialogue GP» we study the architectural challenges such a platform and service poses, and which changes it requires from health personnel's work practice.

Novel web-based and mobile technologies are expected to offer huge opportunities for reconfiguring healthcare towards more patient-centric models for service provision. This project will study the challenges and opportunities that utilization of these tec hnologies poses to the existing digital information infrastructures (the "installed base") in the healthcare sector, and also how the existing infrastructure influences the new technologies: on the one hand the new technologies should build on and utilize the existing information available, and on the other hand, the existing information infrastructures should be flexible enough to allow new service models to emerge. Achieving such a productive interplay is not trivial, as new service models may create te nsions with the existing installed base, both in terms of non-compatibility with established technologies, organizational forms and economic models. In addition, the information infrastructures should also be able to harness the potential for further inno vations arising in an open innovation system where the patients as users have a different role. In order to investigate such tensions, the project will draw on relevant theories from the cross-disciplinary Information Systems field, as well as Organizat ional Theory and Economics. By conducting multiple longitudinal qualitative case studies in hospitals where diverse novel technologies are actually used, we contribute to an improved understanding of the conditions for realizing the transformative potenti al of these technologies, and for making productive use of the existing information infrastructures. By identifying core qualities of "responsive architectures", we seek to define the infrastructure-related requirements, approaches and strategies that can accomodate, support and stimulate such technology-enabled innovative provision of patient-oriented health services. This covers elements of a technological, organizational and economic nature.