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Journal Article

Evolving Structure in the Implementation of Healthcare Information Systems: An Actor‑Network Analysis  pp30-40

Hannu Larsson

© Sep 2011 Volume 9 Issue 1, Editor: Frank Bannister, pp1 - 92

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Public sector ICT use is now moving towards integration of services and processes across departments, for instance in the healthcare sector. This is a challenging issue as it involves distributed decision making, often across both public and private organizations, which implies a multitude of issues. Enterprise Architectures (EA) aim at providing a common framework that includes data, resources and processes, through which all aspects of the enterprise can be directed towards a common goal in an efficient manner. It as been argued that architectures should be perceived as evolving (rather then as carefully planned roadmaps), although more research on how EA evolves is needed. This paper addresses the general question of, how does an EA evolve during implementation? A case study is used to illustrate how an EA evolves throughout the process of implementation. The case is the implementation of a national patient record system in the decentralized Swedish healthcare system. The project is part of a larger effort to implement an EA in the healthcare sector aimed at further integrating the whole sector. Data is collected by means of observations, interviews and document analysis. Using an Actor‑Network Theory perspective, this paper presents four episodes during which an EA evolves through interactions. In this way the paper contributes with a deepened understanding of how EA evolves by arguing that EA programs should be seen as something that needs to be planned with regard to that it will, and should, evolve in order to respond to needs discovered in the process. The contribution is a deepened understanding of how sub‑projects co‑evolve with a national EA project, thus mutually affecting each other. This should not be perceived as something unequivocally negative as this might also be strategic, and leads to evolution of other parts of the EA to suit each other.


Keywords: actor-network theory, eGovernment, eHealth, enterprise architecture, evolving structure, implementation


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Journal Issue

Volume 9 Issue 1 / Sep 2011  pp1‑92

Editor: Frank Bannister

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Ships that Pass in the Night?


For some years now I have been involved in the PhD symposium at the European Group for Public Administration’s (EGPA’s) annual conference.  The majority of the PhD students attending these symposia are doing their research in public administration rather than e‑government, but sometimes ICT raises its head in unexpected situations.


This happened a few weeks ago at this year’s conference in Bucharest when a student was presenting some of the ongoing results from the COCOPS project.  Don’t worry about the acronym ( if you want to know more), COCOPS is an EU funded project which, inter alia is trying to evaluate the impact of various public sector reforms.  In the presentation in question, the student discussed and analysed various attempts to evaluate the impact of New Public Management (NPM) on public administration and citizens over the period from about the early 1990s to the present.


This coincides, give or take a year or two, with the period of the Internet and the Web in government.  So in the discussion afterwards I could not resist asking the obvious question: how are you (or COCOPS) going to differentiate the effect of NPM (or any other reform over this period) from the impact of technology?   This led to a lively discussion at the end of which there was no clear answer – possibly because distilling out such impacts is next to impossible.


The question of evaluating the impact of e‑government is one for another day.  My observation here is that the student, and one assumes that COCOPS team (and a very distinguished bunch they are), did not seem to have given this matter much, if any, thought.  Given that Eric Brynjolfsson is on record as claiming that almost all of the productivity gains in the US economy over the past 20 plus years are attributable to information technology, it seems a bit well, quixotic, to ignore the impact of the same technology in the public sector.  Quixotic maybe, but surprising no.  The world of public administration, or at least the academic end of it, is still, seemingly, largely oblivious of IT.  In fact the previous week at the eGov conference in Delft when I remarked at an IFIP meeting that the Oxford Handbook of Public Management had only two chapters which considered IT at all (and one of those was on IT in government by Helen Margretts) a leading American academic (whose identity I will protect though he has tenure) snorted on contemptuously that that was because public administration academics were still 30 years behind in their thinking.


A bit over the top maybe, but there a germ of truth in this accusation as there is in the sometimes heard counter accusation that too many people working in e‑government do not know enough about mainstream public administration, its concepts, theories and ideas.  A small number academics bridge this divide and many of them are to be found at EGPA each year, but it is a gap that really needs to be addressed by both sides.  Both public administration and e‑government worlds have much to learn from each other and if they could, there world would be the richer for it. 


Frank Bannister

September 2011


Keywords: CIO, local government, Mexico, IT organization, eService, electronic service, public service delivery, eGovernment application, interoperability, integrated service, Bangladesh, actor-network theory, eGovernment, eHealth, enterprise architecture, evolving structure, implementation, participatory budgeting, eDemocracy, Symfony, Quimby, open-source, eDem 1.0, software reuse, electronic PB, TQM, eGovernment, local government, organisational change, certification,


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