Summary
Objectives: While recognized that global actors influence health information system design, studies
of health informatics have largely focused on micro politics of technology design
and implementation. Here a problematic patient care information system (PCIS) is discussed
in relation to federal and provincial policies and corporate strategies to demonstrate
that our understanding of health informatics can be enhanced by linking micro studies
of health informatics to larger macro contexts.
Methods: Interviews and document study.
Results: Although the extent to which federal initiatives influenced (or failed to influence)
provincial and hospital initiatives remains debateable, events initiated at one level
(the hospital’s decision to implement software, initiated at the organizational level)
are influenced (perhaps indirectly) by developments in other contexts (federal /macro
changes gave an initiative more weight; provincial initiatives such as the Labour
Accord altered the industrial relations environment in which system development occurred).
Conclusions: Micro-studies of work practice, invaluable in addressing interactions between technologies,
users and work practices, often fail to account for the historic reach of global actors,
although it is often these historic circumstances that contribute to present-day interactions
between user, information system and organization, and that find expression – often
indirectly – in daily work practices.
Keywords
Information system development - social and political contexts - policy issue
